Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

Abstract

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

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

“…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. In addition, extended intraoperative times and 4 or more levels of lumbar fusion further increase the likelihood of chronic opioid use after spine surgery, 12 and postoperative pain management regimens should be continuously modified to optimize non-opioid pain control as patients recover from surgery.…”

“…11,12 Careful consideration of these patient-level characteristics is warranted when formulating a multimodal pain regimen prior to surgery. In addition, extended intraoperative times and 4 or more levels of lumbar fusion further increase the likelihood of chronic opioid use after spine surgery, 12 and postoperative pain management regimens should be continuously modified to optimize non-opioid pain control as patients recover from surgery. Given the multitude of opioid-related adverse effects and the risks of new-onset depression and anxiety associated with chronic postoperative opioid use, 13 multimodal analgesic regimens optimizing non-opioid pain therapy have been proposed to reduce postoperative opioid requirements.…”

Lower Extremity Osteoarthritis: A Risk Factor for Mental Health Disorders, Prolonged Opioid Use, and Increased Resource Utilization After Single-Level Lumbar Spinal Fusion

“…Preoperative opioid use, preoperative depression and anxiety, smoking, Black race, more levels fused have been previously identified as risk factors for postoperative depression and anxiety and prolonged opioid use after spine surgery. 21,28-30 Based on the results of this study, patients with concomitant lower extremity arthritis are at 20% to nearly 34% increased relative risk of postoperative depression, anxiety, and prolonged opioid use, suggesting that this must be considered as a notable risk factor for postoperative mental health disorders and chronic opioid use.…”

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

“…Similar to our findings, previous authors have identified a wide variation in discharge opioid amounts among spine surgery patients 7,9 and have identified patient-specific and perioperative factors associated with postoperative opioid prescriptions and use. For example, Pugely et al found that patients aged 50 years and older were associated with markedly higher 1-year opioid use after ACDF, 17 whereas Montgomery et al 18 found that younger age was associated with higher rates of opioid use at 3 months after spine surgery. The authors also identified associations between provider type and opioid prescription volumes after surgery, 9 with midlevel providers prescribing markedly higher discharge opioid volumes as compared with residents.…”

“…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…”