Risk Factors for Prolonged Opioid Use and Effects of Opioid Tolerance on Clinical Outcomes After Anterior Cervical Discectomy and Fusion Surgery

Abstract

Study Design. Retrospective study. Objective. The aim of this study was to determine risk factors for prolonged opioid use and to investigate whether opioid-tolerance affects patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) surgery. Summary of Background Data. There is a lack of consensus on risk factors that can affect continued opioid use after cervical spine surgery and the influence of opioid use on patient-reported outcomes. Methods. Ninety-two patients who underwent ACDF for degenerative cervical pathologies were retrospectively identified and their opioid usage before surgery was investigated using a state-sponsored prescription drug monitoring registry. Opioid-naïve and opioid tolerant groups were defined using criteria most consistent with the Federal Drug Administration (FDA) definition. Patient-reported outcomes were then collected, including the Short Form-12 (SF-12) Physical Component (PCS-12) and Mental Component (MCS-12), the Neck Disability Index (NDI), the Visual Analogue Scale Neck (VAS neck) and the Visual Analogue Scale Arm (VAS Arm) pain scores. Logistic regression was used to determine predictors for prolonged opioid use following ACDF. Univariate and multivariate analyses were conducted to compare change in outcomes over time between the two groups. Results. Logistic regression analysis demonstrated that opioid tolerance was a significant predictor for prolonged opioid use after ACDF (odds ratio [OR]: 18.2 [1.46, 226.4], P = 0.02). Duration of usage was also found to be a significant predictor for continued opioid use after surgery (OR: 1.10 [1.0, 1.03], P = 0.03). No other risk factors were found to be significant predictors. Both groups overall experienced improvements in patient-reported outcomes after surgery. Multiple linear regression analysis, controlling for patient demographics, demonstrated that opioid-tolerant user status positively affected change in outcomes over time for NDI (β = −13.7 [−21.8,−5.55], P = 0.002) and PCS-12 (β = 6.99 [2.59, 11.4], P = 0.003) but no other outcomes measured. Conclusion. Opioid tolerance was found to be a significant predictor for prolonged opioid use after ACDF. Additionally, opioid-naïve and opioid-tolerant users experienced overall improvements across PROMs following ACDF. Opioid-tolerance was associated with NDI and PCS-12 improvements over time compared to opioid-naïve users. Level of Evidence: 4

An Update on Postoperative Opioid Use and Alternative Pain Control Following Spine Surgery

“…9 Among surgical specialties, orthopedic and neurosurgery procedures tend to have the highest rates of opioid use, and interventional spinal procedures fall at the intersection of these specialties. 10 Over the past three decades, the diagnoses and treatment of spinal pathologies, such as lumbar stenosis and spondylolisthesis, have increased as the United States experiences an aging population. 11 Meanwhile, opioid use following common procedures such as spinal and/or lumbar fusion operations is strikingly high.…”

Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis

“…These findings could represent potentially modifiable risk factors for orthopaedic surgeons to help prevent the Numerous previous studies have evaluated risk factors for prolonged opioid use after orthopaedic surgery; however, most of these studies focus on patient-specific risk factors, such as medical comorbidities and prior opioid use. [17][18][19][20] In hand surgery specifically, studies have identified preoperative opioid use, alcohol use, smoking history, younger age, lower income, psychiatric disorders, benzodiazepine use, and higher comorbidity scores as risk factors for prolonged postoperative opioid use. 17,18,28 However, very few studies could be identified that investigate how opioid-prescribing patterns of the operating surgeon may contribute to prolonged opioid use.…”

“…Numerous previous studies have evaluated risk factors for prolonged opioid use after orthopaedic surgery; however, most of these studies focus on patient-specific risk factors, such as medical comorbidities and prior opioid use. 17 18 19 20 In hand surgery specifically, studies have identified preoperative opioid use, alcohol use, smoking history, younger age, lower income, psychiatric disorders, benzodiazepine use, and higher comorbidity scores as risk factors for prolonged postoperative opioid use. 17 , 18 , 28 …”

“…15,16 The underlying risk factors for orthopaedic surgery patients developing opioid dependence postoperatively have been a focus of many recent studies. [17][18][19][20] Most studies have investigated patient-specific risk factors such as demographics, comorbidities, and prior substance use. However, few studies have investigated how opioid prescription by the operating surgeon affects prolonged postoperative opioid use, and in those that have, the data are heterogenous and conflicting.…”

Impact of Social Determinants of Health in Spine Surgery

“…Similar to studies published by Adogwa et al and Massie et al, Harris et al found that the rates and duration of chronic opioid use were highest in the Western US ( p -value < 0.001). Additionally, pre-operative opioid, drug abuse, depression, and anxiety were all risks factors of chronic opioid use [ 53 , 59 , 60 ].…”