多学科过渡性疼痛服务对骨科手术后医疗使用和成本的影响。

Minkyoung Yoo, Michael J Buys, Richard E Nelson, Shardool Patel, Kimberlee M Bayless, Zachary Anderson, Julie B Hales, Benjamin S Brooke
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引用次数: 0

摘要

背景:阿片类药物使用障碍是导致发病率、死亡率和医疗费用的一个重要原因。围手术期疼痛管理的过渡性疼痛服务(TPS)方法已被证明可减少骨科关节手术患者阿片类药物的使用。然而,过渡性疼痛服务是否也能降低医疗服务的使用量和成本尚不清楚:我们设计了这项研究,旨在估算相对于标准护理,TPS 的实施对骨科手术后医疗护理使用和相关护理成本的影响。我们采用差异分析法评估了 2018 年至 2019 年期间在美国退伍军人事务部 6 个医疗中心(VAMC)接受骨科关节手术的患者的术后医疗使用情况和成本。在盐湖城退伍军人医疗中心加入 TPS 的患者与在 5 个不同的未加入 TPS 的退伍军人医疗中心接受相同手术的对照组患者进行了配对。我们根据术前阿片类药物使用史将患者分为慢性阿片类药物使用组(COU)和非阿片类药物使用组(NOU),并分别进行分析:对于非阿片类药物滥用患者,TPS 与门诊就诊次数平均增加(6.9 次;P < .001)、门诊费用无变化以及随访 1 年期间住院费用平均减少(-12,170 美元;P = .02)有关。TPS 并未增加 COU 患者的医疗费用:结论:虽然 TPS 增加了 NOU 患者的门诊次数,但骨科手术后的门诊费用并未增加,住院费用也有所下降。此外,使用 TPS 管理 COU 患者也不会增加成本。这些研究结果表明,实施 TPS 可以减少关节手术后阿片类药物的使用,同时不会增加医疗成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of Multidisciplinary Transitional Pain Service on Health Care Use and Costs Following Orthopedic Surgery.

Background: Opioid use disorder is a significant cause of morbidity, mortality, and health care costs. A transitional pain service (TPS) approach to perioperative pain management has been shown to reduce opioid use among patients undergoing orthopedic joint surgery. However, whether TPS also leads to lower health care use and costs is unknown.

Methods: We designed this study to estimate the effect of TPS implementation relative to standard care on health care use and associated costs of care following orthopedic surgery. We evaluated postoperative health care use and costs for patients who underwent orthopedic joint surgery at 6 US Department of Veterans Affairs medical centers (VAMCs) between 2018 and 2019 using difference-in-differences analysis. Patients enrolled in the TPS at the Salt Lake City VAMC were matched to control patients undergoing the same surgeries at 5 different VAMCs without a TPS. We stratified patients based on history of preoperative opioid use into chronic opioid use (COU) and nonopioid use (NOU) groups and analyzed them separately.

Results: For NOU patients, TPS was associated with a mean increase in the number of outpatient visits (6.9 visits; P < .001), no change in outpatient costs, and a mean decrease in inpatient costs (-$12,170; P = .02) during the 1-year follow-up period. TPS was not found to increase health care use or costs for COU patients.

Conclusions: Although TPS led to an increase in outpatient visits for NOU patients, there was no increase in outpatient costs and a decrease in inpatient costs after orthopedic surgery. Further, there was no added cost for managing COU patients with a TPS. These findings suggest that TPS can be implemented to reduce opioid use following joint surgery without increasing health care costs.

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