Opioid utilization following cervical spine surgery: trends and factors associated with long-term use

Publication date: Available online 10 April 2018
Source:The Spine Journal
Author(s): Andrew J. Pugely, Nicholas A. Bedard, Piyush Kalakoti, Nathan R. Hendrickson, Jamal N. Shillingford, Joseph L. Laratta, Comron Saifi, Ronald A. Lehman, K. Daniel Riew
Background ContextLimited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis.PurposeTo assess trends in post-operative narcotic use amongst preoperative opioid users (OU) versus non-opioid users (NOU), and identify factors associated with postoperative narcotic use at 1-year following cervical arthrodesis.Study Design/SettingRetrospective, observational study.Patient Sample17,391 patients (OU: 52.4%) registered in the Humana Inc. claims dataset that underwent anterior (ACF) or posterior cervical fusions (PCF) between 2007-2015.Outcome MeasuresProlonged opioid usage defined as narcotic prescription filling at 1-year following cervical arthrodesis.MethodsBased on preoperative opioid-use, patients were identified as an OU (history of narcotic prescription filled within 3-months before surgery) or a NOU (no preoperative prescription). Rates of opioid use were evaluated pre-operatively for OU, and trended for 1-year post-operatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at 1-year following ACF and PCF. Based on the model findings, a web-based interactive app was developed to estimate 1-year postoperative risk of using narcotics following cervical arthrodesis: https://ift.tt/2GNkVEW or https://ift.tt/2qnnMcl, 87.4% patients (n=15,204) underwent ACF while 12.6% (n=2187) underwent PCF. At one-month following surgery, 47.7% NOU and 82% OUs had a filled opioid prescription. At 3-months, rates of prescription opioids declined significantly to 7.8% in NOUs vs 50.5% in OUs, while plateauing at 6-12 month postoperative period (NOU:5.7-6.7%; OU:44.9-46.9%). At 1-year, significantly higher narcotic prescription filling rates was observed in OUs compared to NOUs (45.3% vs 6.3%;p<0.001). Preoperative opioid use was a significant driver of 1-year narcotic use following ACF (OR:7.02;p<0.001) and PCF (OR:6.98;p<0.001) along with younger age(<=50 years), history of drug-dependence and lower back pain.ConclusionsOver 50% patients used opioids prior to cervical arthrodesis. Postoperative opioid-use fell dramatically during the first 3-months in NOU, but nearly half of the pre-op opioid users will remain on narcotics at 1-year postop. Our findings serve as a baseline in identifying patients at risk for chronic use and encourage discontinuation of opioids prior to cervical spinal surgery.



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