Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Preoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug–use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p &lt; 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17–1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95–0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03–1.25), revision fusions (OR 1.15, 95% CI 1.05–1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04–1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84–1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p &lt; 0.001) and 2 (β = 0.09, p &lt; 0.001) years postoperatively.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Although these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.</jats:p></jats:sec>

Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology

“…Temporal and regional trends were analyzed by logistic regression for binary outcomes and linear regression for continuous variables, controlling for age and sex. For determining risk factors for chronic opioid use, univariate logistic regression was performed on variables of interest in-accordance with previous studies in the literature [24]. Factors that were significant…”

“…There also may be other variables not codified in our data which may affect postoperative opioid use, such as patients with nonspine related chronic pain. Our study is strengthened by the large sample size representative of all United States regions, and rigorous definition of chronic opioid use that requires persistent, long-term use following surgery [24,43,44].…”

“…Prescriptions ≥90 MMED and ≥200 MMED were categorized as high and very high-dose, given the increased risks of such prescriptions [16]. Office of the Inspector General Recommendations were used to identify patients who met criteria for chronic opioid use following surgery, defined as ≥120 days' supply of opioid prescriptions filled or ≥10 opioid prescriptions between 3 and 12 months postoperatively [23,24].…”

Characteristics of fibromyalgia patients prescribed opioid medications: data from the Cleveland clinic fibromyalgia registry

“…Numerous studies have demonstrated that psychological factors predict or are associated with opioid use (reviewed by Darnall et al) [43]. Depression preceding lumbar fusion or total joint arthroplasty is associated with increased opioid use following surgery [44,45]. Psychological factors, such as unstable mental illness, and higher depression rates than in controls, have been associated with opioid prescription and use in FM [37,41].…”

Suffering in Silence: Mental Health Stigma and Physicians' Licensing Fears

“…Traditional teaching on this subject has used a dualistic framework that separates issues of the mind from the body. However, a rapidly growing body of literature highlights the impact of mental health on medical outcomes such as pain, postoperative opioid use, and other chronic health conditions, including diabetes and heart disease (20). These findings reflect an increased understanding of the developmental, physiologic, and neurobiological basis of disease.…”