Study Design. A retrospective cohort study performed in a nationwide insurance claims database. Objective. This study aimed to examine duration and magnitude of postoperative opioid prescriptions following common spinal procedures. Summary of Background Data. Postoperative opioid prescription practices vary widely among providers and procedures and standards of care are not well-established. Previous work does not adequately quantify both duration and magnitude of opioid prescription. Methods. Forty seven thousand eight hundred twenty three patients with record of any of four common spinal procedures in a nationwide insurance claims database were stratified by preoperative opioid use into three categories: “opioid naive,” “sporadic user,” or “chronic user,” defined as 0, 1, or 2+ prescriptions filled in the 6 months preceding surgery. Those with record of subsequent surgery or readmission were excluded. Duration of opioid use was defined as the time between the index surgery and the last record of filling an opioid prescription. Magnitude of opioid use was defined as milligram morphine equivalents (MME) filled by 30 days post-op, converted to 5 mg oxycodone pills for interpretation. Results. Opioid naive patients were less likely than chronic opioid users to fill any opioid prescription after surgery (63–68% naive vs. 91–95% chronic, P < 0.001), and when they did, their prescriptions were smaller in magnitude (76–91 pills naive vs. 127–152 pills chronic). One year after surgery, 15% to 18% of opioid naive and 50% to 64% of chronic opioid users continued filling prescriptions. Conclusion. Opioid naive patients use less postoperative opioids, and for a shorter period of time, than chronic users. This study serves as a normative benchmark for examining postoperative opioid use, which can assist providers in identifying patients with opioid dependence. Importantly, this work calls out the high risk of opioid exposure, as 15% to 18% of opioid naive patients continued filling opioid prescriptions 1 year after surgery. Level of Evidence: 3
Study Design: Retrospective, database review. Objectives: Examine the utilization rate of postoperative deep vein thrombosis (DVT) prophylaxis and compare the incidence and severity of bleeding and thrombotic complications in elective spine surgery patients. Methods: We utilized PearlDiver, a national orthopedics claims database. All patients who underwent elective spine surgery from 2007 to 2017 were included. Patients were stratified by the presence of DVT prophylaxis drug codes, then by comorbidities for postoperative bleeding/thrombosis. The severity of all bleeding and thrombotic complications in each cohort was studied, including the incidence of complications requiring operative washout, diagnosis of pulmonary embolism, intensive care unit admission, and mortality. Results: A total of 119 888 patients were included. The majority of patients (118 720, >99%) were not administered postoperative DVT chemoprophylaxis while a minority of patients (1168) were. The overall rates of bleeding and thrombotic complications within the population not receiving DVT prophylaxis were 1.96% and 2.45%, respectively ( P < .001). The incidence of surgical intervention for a wound washout was 0.62% compared with 1.05% for pulmonary embolism ( P < .001). Intensive care unit admission rates related to a wound washout procedure or pulmonary embolism also significantly differed (0.07% vs 0.34%, P < .001). There were no observed differences in mortality. When controlling for patient comorbidity, patients with atrial fibrillation, cancer, or a prior history of thrombotic complications experienced the greatest increased risks of postoperative thrombosis. Conclusions: DVT prophylaxis is not routinely utilized following elective spine procedures. We report that there exist specific populations which may receive benefit from these practices, although further study is necessary to determine optimal prevention strategies for both thrombotic and bleeding complications in spine surgery.
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