{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:24:12Z","timestamp":1753892652451,"version":"3.41.2"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T00:00:00Z","timestamp":1705363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K08","MH125069"],"award-info":[{"award-number":["K08","MH125069"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Pediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and nineteen patients (mean age = 30.9 \u00b1 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (<jats:italic>n<\/jats:italic> =\u200998) of the participants were female and 90.8% (<jats:italic>n<\/jats:italic>\u2009=\u2009108) were non-Hispanic\/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4\u2009years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z\u2009=\u2009\u22123.36, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z\u2009=\u2009\u22122.86, <jats:italic>p<\/jats:italic>\u2009=\u20090.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Median arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2023.1166744","type":"journal-article","created":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T04:18:14Z","timestamp":1705378694000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease"],"prefix":"10.3389","volume":"14","author":[{"given":"Christopher L.","family":"Skelly","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen","family":"Stiles-Shields","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayley","family":"Goldenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Bohr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estee","family":"Feldman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace Zee","family":"Mak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Drossos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.healthpol.2014.12.016","article-title":"Socio-economic burden of rare diseases: a systematic review of cost of illness evidence","volume":"119","author":"Angelis","year":"2015","journal-title":"Health Policy"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/nrd1961","article-title":"The IBS market","volume":"5","author":"Ashburn","year":"2006","journal-title":"Nat Rev Drug Discov"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.jvs.2022.10.022","article-title":"Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort","volume":"77","author":"DeCarlo","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.jamcollsurg.2012.10.004","article-title":"Laparoscopic median arcuate ligament release: are we improving symptoms?","volume":"216","author":"El-Hayek","year":"2013","journal-title":"J. Am. Coll. Surg."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1111\/pme.12202","article-title":"The cost of chronic pain: an analysis of a regional pain Management Service in Ireland","volume":"14","author":"Gannon","year":"2013","journal-title":"Pain Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1001\/jamapediatrics.2015.1915","article-title":"Racial disparities in pain Management of Children with Appendicitis in emergency departments","volume":"169","author":"Goyal","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref7","first-page":"547","article-title":"A rare obstruction of the coeliac artery","volume":"52","author":"Harjola","year":"1963","journal-title":"Ann Chir Gynaecol Fenn"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1016\/j.jpeds.2015.07.058","article-title":"Annual costs of Care for Pediatric Irritable Bowel Syndrome, functional abdominal pain, and functional abdominal pain syndrome","volume":"167","author":"Hoekman","year":"2015","journal-title":"J Pediatr."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1017\/S0266462313000160","article-title":"Consolidated health economic evaluation reporting standards (CHEERS) statement","volume":"29","author":"Husereau","year":"2013","journal-title":"Int. J. Technol. Assess. Health Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1097\/rct.0b013e318032e8c9","article-title":"Median arcuate ligament syndrome: multidetector computed tomography findings","volume":"31","author":"Ilica","year":"2007","journal-title":"J. Comput. Assist. Tomogr."},{"year":"2022","key":"ref12"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"E851","DOI":"10.1542\/peds.2012-3127","article-title":"Association of Race and Ethnicity with Management of abdominal pain in the emergency department","volume":"132","author":"Johnson","year":"2013","journal-title":"Pediatrics"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1089\/lap.2013.0438","article-title":"Pediatric median arcuate ligament syndrome: surgical outcomes and quality of life","volume":"24","author":"Joyce","year":"2014","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1038\/nrgastro.2015.150","article-title":"The global burden of IBD: from 2015 to 2025","volume":"12","author":"Kaplan","year":"2015","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1016\/j.cgh.2020.06.065","article-title":"Prevalence and characteristics of abdominal pain in the United States","volume":"19","author":"Lakhoo","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref17","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-33293-2_22","article-title":"In patients with celiac artery compression syndrome, does surgery improve quality of life?","volume-title":"Difficult Decisions in Vascular Surgery: An Evidence-Based Approach","author":"Mak","year":"2017"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e257","DOI":"10.3928\/00904481-20160613-01","article-title":"Pediatric chronic abdominal pain and median arcuate ligament syndrome: a review and psychosocial comparison","volume":"45","author":"Mak","year":"2016","journal-title":"Pediatr. Ann."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1016\/j.jpedsurg.2013.03.003","article-title":"Median arcuate ligament syndrome in the pediatric population","volume":"48","author":"Mak","year":"2013","journal-title":"J. Pediatr. Surg."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"686","DOI":"10.1046\/j.1525-1497.1997.07142.x","article-title":"Health-related quality of life after elective surgery - measurement of longitudinal changes","volume":"12","author":"Mangione","year":"1997","journal-title":"J. Gen. Intern. Med."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1007\/s11999-011-1770-9","article-title":"Defining racial and ethnic disparities in pain management","volume":"469","author":"Mossey","year":"2011","journal-title":"Clin Orthop Relat Res"},{"volume-title":"Race and National Origin","year":"2023","key":"ref22"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3348\/kjr.2001.2.1.8","article-title":"Celiac axis stenosis: incidence and etiologies in asymptomatic individuals","volume":"2","author":"Park","year":"2001","journal-title":"Korean J. Radiol."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.jvs.2018.04.062","article-title":"Inability of conventional imaging findings to predict response to laparoscopic release of the median arcuate ligament in patients with celiac artery compression","volume":"69","author":"Patel","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1053\/j.gastro.2021.10.017","article-title":"Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2021","volume":"162","author":"Peery","year":"2022","journal-title":"Gastroenterology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1111\/j.1651-2227.2007.00291.x","article-title":"The impact of recurrent abdominal pain: predictors of outcome in a large population cohort","volume":"96","author":"Ramchandani","year":"2007","journal-title":"Acta Paediatr."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/0741-5214(85)90177-6","article-title":"Late results following operative repair for celiac artery compression syndrome","volume":"2","author":"Reilly","year":"1985","journal-title":"J. Vasc. Surg."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/j.jvs.2014.11.040","article-title":"Celiac artery decompression for median arcuate ligament syndrome: a United States National Inpatient Sample Study","volume":"61","author":"Rezigh","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1542\/peds.2012-2191","article-title":"Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders","volume":"132","author":"Shelby","year":"2013","journal-title":"Pediatrics"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"151129","DOI":"10.1016\/j.sempedsurg.2021.151129","article-title":"Median arcuate ligament syndrome - current state of management","volume":"30","author":"Skelly","year":"2021","journal-title":"Semin. Pediatr. Surg."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1016\/j.jvs.2022.11.046","article-title":"Median arcuate ligament syndrome: surgical approaches to a rarely diagnosed and undertreated disease","volume":"77","author":"Skelly","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1414","DOI":"10.1016\/j.jvs.2017.12.078","article-title":"The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome","volume":"68","author":"Skelly","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref33","first-page":"159","article-title":"Psychosocial and psychosomatic diagnoses in primary care of children","volume":"66","author":"Starfield","year":"1980","journal-title":"Pediatrics"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3389\/fpsyg.2021.695435","article-title":"Targeting coping to improve surgical outcomes in pediatric patients with median arcuate ligament syndrome: feasibility study","volume":"12","author":"Stiles-Shields","year":"2021","journal-title":"Front. Psychol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1037\/cpp0000355","article-title":"Patient-reported experiences with median arcuate ligament syndrome: resilience and resources required","volume":"10","author":"Stiles-Shields","year":"2022","journal-title":"Clin Pract Pediatr Psychol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1097\/MPG.0000000000001900","article-title":"Psychological factors and outcomes in the surgical treatment of pediatric patients with median arcuate ligament syndrome","volume":"66","author":"Stiles-Shields","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref37","first-page":"849","article-title":"The celiac artery compression syndrome: does it exist?","volume":"72","author":"Szilagyi","year":"1972","journal-title":"Surgery"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/j.jvs.2010.05.083","article-title":"Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome","volume":"52","author":"Tulloch","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.jvs.2008.12.077","article-title":"Retroperitoneal endoscopic release in the management of celiac artery compression syndrome","volume":"50","author":"van Petersen","year":"2009","journal-title":"J. Vasc. Surg."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"100840","DOI":"10.1016\/j.cppeds.2020.100840","article-title":"Updates in diagnosis and management of chronic abdominal pain","volume":"50","author":"Yarger","year":"2020","journal-title":"Curr Probl Pediatr Adolesc Health Care"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1166744\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T04:18:20Z","timestamp":1705378700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1166744\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,16]]},"references-count":40,"alternative-id":["10.3389\/fpsyg.2023.1166744"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2023.1166744","relation":{},"ISSN":["1664-1078"],"issn-type":[{"type":"electronic","value":"1664-1078"}],"subject":[],"published":{"date-parts":[[2024,1,16]]},"article-number":"1166744"}}