A. J. Schoenfeld1, W. Jiang1, M. A. Chaudhary1, R. Scully1, A. Haider1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA
Introduction:
There is a growing concern that the use of prescription opioids following elective surgical interventions may predispose patients to chronic opioid use and abuse. This concern is especially prevalent for patients undergoing elective orthopaedic procedures and spine surgery in particular. The prevalence of sustained opioid use in this population, especially among narcotic naive populations, has not been explored previously. In addition, risk factors for sustained opioid use and the role of surgical intensity in mediating such risks are not well understood. We sought to estimate the proportion of patients using opioids up to 1-year following discharge for common spine surgical procedures and identify factors associated with sustained opioid use.
Methods:
This study utilized 2006-2014 claims data from TRICARE insurance maintained by the Department of Defense. Adults (18-64 years) who received one of four common spine surgical procedures (discectomy, decompression, posterolateral fusion or interbody fusion) between 2007-2013 were identified. Patients with prior opioid use, as defined by use within the 6 months preceding the index procedure, were excluded. Posterolateral fusion and interbody fusion were considered procedures of higher intensity, discectomy and decompression were considered to be lower intensity. Covariates included demographic factors, pre-operative diagnoses, comorbidities, post-surgical complications and mental health disorders. Prescription opioid use was evaluated up to one-year following discharge. Risk-adjusted Cox Proportional-hazards models were used to evaluate predictors of sustained opioid use.
Results:
This study included 4,798 patients. Eighty-one percent filled at least one opioid prescription following discharge. At 30 days following discharge, 9% continued opioid use, while 2% continued use at 3-months and 0.3% at 6-months. When adjusted for pre-operative diagnosis, less intense surgical procedures were associated with a higher likelihood of opioid discontinuation (HR 1.42, 95% CI 1.32, 1.53). Lower socioeconomic status (HR 0.79, 95% CI 0.66-0.95), depression (HR 0.80, 95% CI 0.71, 0.91) and anxiety (HR 0.68, 95% CI 0.49, 0.95) were significantly associated with a decreased likelihood of discontinuing opioid use.
Conclusion:
By 6-months following discharge, nearly all patients had discontinued opioid use after spine surgery. As only 0.3% of patients continued opioid use more than 6-months following surgery, these results indicate that spine surgery among opioid naive patients is not a major driver of long-term prescription opioid use. Socioeconomic status and pre-existing diagnoses of anxiety and depression may be factors associated with sustained opioid use after spine surgery.
