Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

Harris, Andrew B.; Marrache, Majd; Jami, Meghana; Raad, Micheal; Puvanesarajah, Varun; Hassanzadeh, Hamid; Lee, Sang H.; Skolasky, Richard L.; Bicket, Mark C.; Jain, Amit

doi:10.1016/j.spinee.2019.09.011

Cited by 31 publications

(35 citation statements)

References 31 publications

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“…Several recent publications have highlighted a critical need for standardization of how opioid availability or use is described preoperatively and postoperatively across surgery types. 19,20 Criteria to define a lack of preoperative opioid availability or use have included no self-reported opioid use or prescription availability at the time of surgery, 1,4,7,21 no prescription opioid availability between 90 and 7 days before surgery, 22 no opioid availability in the 180 days before surgery, 5,8,23 no opioid availability in the 12 months before surgery, 24 and no opioid availability from 365 to 7 days before surgery. 25 Some studies report opioid use or availability as a dichotomous variable (yes or no), whereas others analyzed opioid dose typically in oral morphine equivalents.…”

Section: Discussionmentioning

confidence: 99%

Association Between Spine Surgery and Availability of Opioid Medication

et al. 2020

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IMPORTANCE Prolonged prescribing of opioids after spine surgery is often perceived as a negative outcome, but successful opioid reduction may occur despite continued prescribing. Improved characterization of opioid availability before and after surgery is necessary to identify these successes.OBJECTIVE To evaluate the association between spine surgery and modification of opioid availability postoperatively by using consistent definitions to classify opioid availability before and after surgery. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study included 2223 adults (age Ն18 years) who underwent spine surgery in

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Section: Discussionmentioning

confidence: 99%

Association Between Spine Surgery and Availability of Opioid Medication

et al. 2020

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“…Further, it is 886 www.e-neurospine.org important to note that opioid prescription was used as a proxy for opioid use, similar to other studies on this topic. 23,41 Lastly, the cohort included in the database only consists of private payers under age 65 who have prescription coverage, most of whom are employed. The external validity may not be applicable to older patients and those who are uninsured or covered by government programs.…”

Section: Discussionmentioning

confidence: 99%

“…We defined chronic opioid use as receiving a cumulative opioid quantity of ≥ 120 days' supply or ≥ 10 different opioid prescriptions filled between postoperative months 3-12. This definition has been utilized in previous studies 22,23 and is based on Office of the Inspector General Recommendations. 24…”

Section: Opioid Utilizationmentioning

confidence: 99%

Chronic Opioid Use Following Lumbar Discectomy: Prevalence, Risk Factors, and Current Trends in the United States

et al. 2020

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“…Health and Human Services has labeled it a public health emergency. 4,11,14 Orthopaedic surgeons have one of the highest opioid prescribing rates of any health care profession. 23 Anterior cruciate ligament (ACL) reconstruction is a painful procedure, and postoperative range of motion and rehabilitation exercises are extremely important; therefore, there has been an emphasis on postoperative pain control.…”

mentioning

confidence: 99%

“…16 The opioid crisis has received significant press in the past few years, and the Department of Health and Human Services has labeled it a public health emergency. 4,11,14 Orthopaedic surgeons have one of the highest opioid prescribing rates of any health care profession. 23…”

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confidence: 99%

Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction

et al. 2020

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Introduction: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction. Hypothesis: Regional differences in opioid prescribing patterns after ACL reconstruction are present. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed. Results: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present ( P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017). Conclusion: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing. Clinical Relevance: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.

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Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

Cited by 31 publications

References 31 publications

Association Between Spine Surgery and Availability of Opioid Medication

Association Between Spine Surgery and Availability of Opioid Medication

Chronic Opioid Use Following Lumbar Discectomy: Prevalence, Risk Factors, and Current Trends in the United States

Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction

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