145. Opioid utilization in adult idiopathic scoliosis after multilevel deformity correction: postoperative trends and factors associated with long-term use

Piyush Kalakoti; Alan Shamrock; Joshua M. Eisenberg; Nathan R. Hendrickson; Joseph L. Laratta; Andrew J. Pugely

doi:10.1016/j.spinee.2019.05.159

Opioid therapy is effective in alleviating acute postoperative pain. However, benefits of chronic opioid therapy (COT) is a contentious issue corollary to concerns relating to long-term drug dependence, tolerance and misuse. Patients with adult spinal deformities (ASD) undergoing complex, multilevel fusions often require optimized pain management strategies tailored upon disease progression and the extent of deformity correction. In alignment with a national focus on regulating lenient prescription practices, investigating epidemiological trends and risk factors associated with postoperative consumption in patients with ASD can be beneficial in understanding atypical opioid requirements, guiding practice surveillance, and implementing preventive strategies. To assess trends in postoperative opioid use in preoperative opioid users (OU) vs opioid-naïve (ON) and identify risk-factors associated with long-term use (at one year) after deformity correction for adult idiopathic scoliosis (IS). Retrospective, observational cohort study. A total of 1,894 adults who underwent primary short (4-8 vertebrae) or long fusions (≥ 9 vertebrae) for IS. Monthly, active postoperative opioid prescription rates up to one year in OUs and ON, and risk factors associated with long-term opioid use after surgical correction. A commercial claims dataset (The Humana Inc.) was queried to longitudinally track monthly postoperative opioid use up to a year after surgical correction. Preop active opioid prescription within three months prior to surgery was used as a surrogate marker for defining patients as OUs vs ON (no active prescription). Multivariable regression models identified factors associated with opioid use at one year. A total of 1606 (84.8%) patients underwent deformity correction involving 4-8 vertebral levels vs 288 (15.4%) with long fusions (≥ 9 vertebrae). Of those, 66.8% were OUs. At one month postop, 79.6% OUs vs 54.2% ON had filled an opioid prescription. At the second month, the absolute risk reduction in opioid use was 55% in ONs (24.6% with active prescription) vs <20% in OUs (64.2% with active prescription). At the third postoperative month, rates of active prescription declined significantly to 15.5% in ONs vs 59.3% in OUs, while plateauing at 6-12-months postop (ON:8.7-12.2%; OU:46.9-51.7%). At one year, a significant proportion of OUs had an active prescription vs ON (47.4% vs 11.9%; p<0.001). Preoperative opioid use was a significant driver of an active prescription at one year following short- (OR:5.0; p<0.001) or long-fusion surgery (OR:11.4; p<0.001). Additional risk factors associated with long-term opioid-use after short-fusion correction were chronic lung disease (OR:1.4; p=0.002), history of drug abuse (OR:1.6; p=0.019), and age < 50 years (OR:2.1 p=0.015) whereas smoking (OR:1.1;p=0.029) and seizure disorders (OR:1.6;p=0.048) were attributable factors associated with increased risk after long fusions. Two-thirds of patients undergoing multilevel deformity correction for adult IS will use opioids prior to surgery. Nonexposure to opioids one-quarter prior to surgery was associated with dramatic risk reduction in postoperative requirements after the third postop month, underscoring the importance of preop opioid tapering protocol. With nearly 50% of OUs having an active prescription at one year following deformity correction, the identified risk factors will serve as an adjunct to preoperative risk stratification and mitigating atypical opioid requirements. This abstract does not discuss or include any applicable devices or drugs.

145. Opioid utilization in adult idiopathic scoliosis after multilevel deformity correction: postoperative trends and factors associated with long-term use

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