Increased Healthcare Costs and Opioid Use in Patients With Anxiety and Depression Undergoing Rotator Cuff Repair

Purpose: The purpose of this study was to 1) quantify the prevalence of mood disorders in patients undergoing arthroscopic rotator cuff repair using a large claims database and 2) compare opioid use and medical costs in the year before and the year after rotator cuff repair between those with and without comorbid mood disorders.

Methods: The Truven Healthcare Marketscan database was queried to identify those who underwent arthroscopic rotator cuff repair (RCR; CPT code 29827) between October, 2010 and December, 2015. All patients were then screened for insurance claims relating to either anxiety or depression. We then compared net costs and opioid use both one year preoperatively and one year postoperatively between those with and without mood disorders using an analysis of covariance (ANCOVA).

Results: A total of 170,329 patients (97,427 males (57.2%) and 72,902 females (42.8%)) undergoing arthroscopic rotator cuff repair were identified. Of the 170,329 patients, 46,737 (27.4%) had comorbid anxiety or depression, and after adjusting for preoperative cost, sex, age, and both preoperative and postoperative opioid use, the one-year postoperative costs for those with a preoperative mood disorder was 7.05% higher than for those without a mood disorder. In addition, opioid use both in the 180 days prior to surgery (36.7% vs. 26.9%) and more than 90 days after surgery (33.0% vs. 27.2%) were substantially greater in the group with comorbid depression or anxiety.

Conclusion: In patients with comorbid mood disorders, opioid use and healthcare costs were increased both preoperatively and postoperatively. The increased cost in this patient population is estimated at $62.3 million annually. In an effort to provide high quality value-based care, treatment strategies should be developed to identify these patients preoperatively and provide the appropriate resources needed to improve the probability of a successful surgical outcome.