Association of Duration of Preoperative Opioid Use with Reoperation After One-level Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients

Abstract

Study Design. Retrospective cohort study.Objective. The aim of this study was to determine that rates of preoperative opioid use in patients undergoing single-level anterior discectomy and fusion (ACDF) without myelopathy and determine the association with reoperations over 5 years Summary of Background Data. Preoperative opioid use before cervical spine surgery has been linked to worse postoperative outcomes. However, no studies have determined the association of duration and type of opioid used with reoperations after ACDF. Methods. Patients undergoing single-level ACDF without myelopathy between 2007 and 2016 with at least 5-year follow-up were identified in one private insurance administrative database. Preoperative opiate use was divided into acute (within 3 months), subacute (acute use and use between 3 and 6 months), and chronic (subacute use and use before 6 months) and by the opiate medication prescribed (tramadol, oxycodone, and hydrocodone). Postoperative rates of additional cervical spine surgery were determined at 5 years and multivariate logistic regression was used to determine the association of preoperative opiates with additional surgery. Results. Of 445 patients undergoing single-level ACDF without myelopathy, 66.3% were taking opioid medications before surgery. The most commonly used preoperative opioid was hydrocodone (50.3% acute use, 24.7% chronic use). Opioidnaı ¨ve patients had a 5-year reoperation rate of 4.7%, compared to 25.0%, 15.5%, and 23.3% with chronic preoperative use of tramadol, hydrocodone, and oxycodone. In multivariate analysis, controlling for age, sex, and Charlson Comorbidity Index, chronic use of hydrocodone (odds ratio [OR] ¼ 2.08, P ¼ 0.05), oxycodone (OR ¼ 4.46, P < 0.01), and tramadol (OR ¼ 4.01, P ¼ 0.01) were all associated with increased reoperations. However, acute use of hydrocodone, oxycodone, and tramadol was not associated with reoperations (P > 0.05). Conclusion. Both subacute and chronic use of common lowerdose opioid medications is associated with increased reoperations after single-level ACDF in nonmyelopathic patients. This information is critical when counseling patients preoperatively and developing preoperative opioid cessation programs.

Comparison of Postoperative Opioid Use After Anterior Cervical Diskectomy and Fusion or Posterior Cervical Fusion

“…Similarly, patients with prolonged opioid use and increased opioid requirements are more likely to experience reoperations, readmissions, complications, and increased cost of care. 32,33…”

“…Similarly, patients with prolonged opioid use and increased opioid requirements are more likely to experience reoperations, readmissions, complications, and increased cost of care. 32,33 Even among opioid-naïve patients, PCF still led to significantly greater opioid use in the short-term postoperative period. In addition, persistent opioid prescriptions were significantly more likely if patients were prescribed opioids within 1 month of surgery.…”

Optimizing Preoperative Chronic Pain Management in Elective Spine Surgery Patients

“…Hills et al reported that chronic users were less likely to return to work by 1 year and had an increased 90-day complication rate compared with those without chronic preoperative opioid use, controlling for disability scores, depression, anxiety, and other covariates that may affect return-to-work and complication rates 16 . Reoperation rates were also lower in opioid-naive patients at 5 years after one-level anterior cervical discectomy and fusion (ACDF) surgery (4.7%) compared with chronic preoperative users of tramadol (25%), hydrocodone (15.5%), or oxycodone (23.3%) 13 . Of note, acute use of any 3 of those opioids was not associated with reoperation.…”

“…For patients with spine pathology considering surgery, increasing evidence suggests that preoperative opioid use negatively affects outcomes after spine surgery 7 . It is estimated that the rate of spine patients considering surgery on opioids perioperatively ranges from 20% to greater than 60% [8][9][10][11][12][13] . Understanding how to optimize these patients for surgery through preoperative weaning periods and maximum dose thresholds will be crucial in improving patient outcomes.…”

Association Between Patient Reported Outcomes Measurement Information System Physical Function With Postoperative Pain, Narcotics Consumption, and Patient-Reported Outcome Measures Following Lumbar Microdiscectomy

“…Postsurgical outcome measures of major interest to spine surgeons and patients include postoperative pain and narcotics utilization. [10][11][12][13][14] These variables are especially important to consider for ambulatory procedures, 15 such as lumbar microdiscectomy, since they may dictate case order, possible overnight admission, and outpatient opioid prescriptions. Currently, data on clinical utility of preoperative PROMIS-PF in predicting immediate postoperative pain, narcotics consumption, and other long-term PROMs after lumbar microdiscectomy is lacking.…”