Predictive Risk Factors Associated With Increased Opioid Use Among Patients Undergoing Elective Spine Surgery

Abstract

Background: Opioids are commonly used for postoperative pain management in spine surgery. However, few guidelines exist for appropriate prescribing in the acute postoperative phase of care. We identify risk factors for inpatient (IP) opioid use and examine relationships between IP requirements and discharge (DC) opioid prescriptions.Methods: Retrospective review of elective spine surgeries between January 2014 and May 2018 identified cases of lumbar decompression (LD), LD with fusion (LDF), and cervical decompression with fusion (CDF) at our high-volume spine center. Multiple regression examining potential risk factors for opioid use was performed. Opioid use was normalized into daily morphine milligram equivalents (MME).Results: A total of 2281 patients who underwent 1251 LD, 384 LDF, and 648 CDF procedures were identified (54.1% male, mean age ¼ 57.9 years, mean body mass index ¼ 30.3 kg/m 2 , median American Society of Anesthesiologists [ASA] score ¼ 2). Mean IP opioid use was 44.4 MME/day and average DC prescriptions totaled 496.5 MME. Multiple regression models identified younger age and increased ASA score as predictive of increased daily IP opioid consumption (b AGE ¼À0.36, P , .001, b ASA ¼ 10.1, P , .001; R 2 ¼ 0.308) and increased DC opioid amounts (b AGE ¼À4.62, P , .001, b ASA ¼ 72.1, P , .001; R 2 ¼ 0.097). Highest IP and DC opioid use was observed among LDF followed by CDF and LD patients. Significant positive correlations were found between IP opioid usage and DC opioid prescriptions by IP opioid quartiles (r ¼ 0.99 LD, 0.98 LDF, 0.96 CDF).Conclusions: Younger patients and higher ASA scores correlated with increased IP opioid use and DC opioid prescriptions. DC prescriptions appropriately reflect IP use.Level of Evidence: 3. Clinical Relevance: Adequate pain management is an integral component to successful outcomes in spine surgery. Awareness of candidates likely to require higher levels of opioid analgesia will be beneficial in guiding surgeon prescribing practices. Complications

Predictive Factors for Postoperative Opioid Use in Elective Endoscopic Endonasal Skull Base Surgery

“…In studies by Bernstein et al and Roof et al, patients who underwent revision total hip arthroplasty used 135.5 MME at 24 h postoperatively, and patients who underwent total knee arthroplasty used 38.4 ± 0.4 MME per day 17,18 . In a study by Sanford et al, patients who underwent lumbar decompression, cervical decompression with fusion, and lumbar decompression with fusion used on average 19.7 ± 0.9, 65.0 ± 2.0, and 105.3 ± 4.1 MME postoperatively per day, respectively 19 …”

“…17,18 In a study by Sanford et al, patients who underwent lumbar decompression, cervical decompression with fusion, and lumbar decompression with fusion used on average 19.7 AE 0.9, 65.0 AE 2.0, and 105.3 AE 4.1 MME postoperatively per day, respectively. 19…”

Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

“…In an attempt to compare skull base craniotomies to other surgical procedures, we identified studies in the literature that report MME over 24 to 72 hours postoperatively for other surgical procedures (►Table 6). [10][11][12][13][14][15] In comparison, patients undergoing head and neck procedures require significantly fewer opioids Skull base craniotomy fell within the range seen in other spine and joint procedures. Patients who underwent lumbar decompression, lumbar decompression with fusion, or cervical decompression with fusion consumed 19.7 AE 0.9, 105.3 AE 4.1, and 65.0 AE 2.0 MME postoperatively daily, respectively.…”

“…In an attempt to compare skull base craniotomies to other surgical procedures, we identified studies in the literature that report MME over 24 to 72 hours postoperatively for other surgical procedures ( Table 6 ). 10 11 12 13 14 15 In comparison, patients undergoing head and neck procedures require significantly fewer opioids than skull base craniotomies. Published benchmarks include endoscopic sinus surgery (23.1 mean MME at 24 hours postoperatively), 10 orthognathic surgery (48.0 mean MME at 24 hours postoperatively), 11 and nonaerodigestive head and neck surgery (40.5 ± 30.6 MME within the 24-hour postoperative period).…”

“…Patients who underwent lumbar decompression, lumbar decompression with fusion, or cervical decompression with fusion consumed 19.7 ± 0.9, 105.3 ± 4.1, and 65.0 ± 2.0 MME postoperatively daily, respectively. 13 Bernstein et al 14 identified that patients who underwent primary total hip arthroplasty required 44.03 mean MME, significantly less compared with patients who underwent revision total hip arthroplasty, who required 135.5 mean MME at 24 hours after surgery. Total knee arthroplasty was found to require an average of 38.43 ± 0.42 MME per day when adjusting for patient factors such as body mass index, smoking status, insurance, and race according to Roof et al 15…”