Risk Factors For Prolonged Opioid Use After Spine Surgery

Abstract

Study Design: Retrospective review. Objective: Our purpose was to evaluate factors associated with increased risk of prolonged post-operative opioid pain medication usage following spine surgery, as well as identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. Methods: The MarketScan commercial claims and encounters database includes approximately 39 million patients per year. Patients undergoing cervical and lumbar spine surgery between the years 2005-2014 were identified using CPT codes. Pre-operative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications, and diabetes were queried and documented. Patients who utilized opioids from 1-3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed pre- and post-operative narcotic medications up to 1 month prior to surgery. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. Results: 553,509 patients who underwent spine surgery during the 10-year period were identified. 34.9% of patients utilized opioids 1-3 months pre-operatively. 25% patients were still utilizing opioids at 6 weeks, 17.3% at 3 months, 12.7% at 6 months, and 9.0% at 1 year after surgery. Pre-operative opioid exposure was associated with increased likelihood of post-operative use at 6-12 weeks (OR 5.45, 95% CI 5.37-5.53), 3-6 months (OR 6.48, 95% CI 6.37-6.59), 6-12 months (OR 6.97, 95% CI 6.84-7.11), and >12 months (OR 7.12, 95% CI 6.96-7.29). Mental health diagnosis, tobacco usage, diagnosis of chronic pain or CRPS, and non-narcotic neuromodulatory medications yielded increased likelihood of prolonged post-op opioid usage. Conclusions: Pre-operative narcotic use and several patient comorbidities diagnoses are associated with prolonged post-operative opioid usage following spine surgery. Chronic opioid use, diagnosis of chronic pain, or use of non-narcotic neuromodulatory medications have the highest risk of prolonged post-operative opioid consumption. Patients using opiates pre-operatively did have an increased 30 and 90-day readmission risk, in addition to a number of serious post-operative complications. This data provides spine surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers, and payers with information on complications associated with pre-operative opioid utilization.

Lumbar spine surgery reduces postoperative opioid use in the veteran population

“…While there was overall a large reduction in patients on opioids postoperatively in the high and low opioid groups, this study also demonstrated that greater preoperative opioid use was associated with a significantly increased risk of postoperative use beyond the immediate postoperative period (90–455 days). These results align with prior literature which has demonstrated greater preoperative opioid use to be a significant predictor of decreased postoperative opioid independence following spine surgery ( 26 - 29 ). This association is not limited to spine surgery and has also been demonstrated in other types of orthopaedic surgery including elective total joint arthroplasty ( 30 ).…”

Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review

“…2,9,10 Approximately 9% of patients continue to use opioids one year after spine surgery. 11 Risk factors for persistent opioid use after spine surgery include preoperative opioid use, depression, anxiety, chronic pain diagnoses, use of non-opioid pain medications, lower socioeconomic status, and younger age. 11,12 Careful consideration of these patient-level characteristics is warranted when formulating a multimodal pain regimen prior to surgery.…”

Factors Associated With Total Discharge Opioid Prescription Morphine Milligram Equivalent Amounts Following Primary Anterior Cervical Spine Surgery

“…19 Studies have also found associations between preoperative opioid use and increased postoperative opioid quantity and duration of use after spine surgery. 18,20–22…”