The association between opioid misuse or abuse and hospital-based, acute care after spinal surgery: a retrospective cohort study

Abstract

Background: Despite a growing prevalence of opioid use, the impact of opioid misuse or abuse (OMA) on surgical outcomes after spinal fusion surgery is ill-defined. This study was conducted to describe the relationship between a patient’s history of OMA and postoperative outcomes. Methods: Using the 2008-2013 Florida, Nebraska, and New York state inpatient databases, the authors identified adult patients who underwent thoracolumbar spinal fusion for degenerative disc disease and postsurgical syndromes. Patients were then subgrouped according to a history of OMA. Regression models were used to describe the association between a history of OMA and in-hospital outcomes, hospital based, acute care after discharge, and subsequent encounters for OMA. Results: The final sample included 73,442 patients including 1,332 patients with a history of OMA. Patients with this history tended to be younger, have a history of smoking (63.7% vs. 30.9%) and chronic pain (20.9% vs. 2.0%), and have revision surgery (5.6% vs. 3.9%). In the adjusted analyses, patients with a history of OMA had longer lengths of stay (4.5 vs. 3.8 days), higher healthcare charges ($129,264 vs. $118,065), and were more likely be readmitted within 1 yr (adjusted odds ratio=2.88), including hospital encounters which were OMA-specific 16.3% vs. 0.8). Conclusions: Patients with a history of OMA consume greater healthcare resources following spinal fusion surgery. It is important to identify these at-risk patients prior to surgery so their care can be tailored appropriately. Level of Evidence: Level III.