Abstract
Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 74. Opioid utilization following cervical spine surgery: trends and factors associated with long-term use
The spine journal, Vol.18(8), pp.S36-S36
08/2018
DOI: 10.1016/j.spinee.2018.06.085
Abstract
Limited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis.
To assess trends in postoperative narcotic use amongst preoperative opioid users (OU) versus nonopioid users (NOU), and identify factors associated with postoperative narcotic use at one year following cervical arthrodesis.
Retrospective, observational cohort study with longitudinal follow-up.
A total of 17,391 patients (OU: 52.4%) registered in the Humana Inc. claims dataset that underwent anterior (ACF) or posterior cervical fusions (PCF) between 2007 and 2015.
Prolonged opioid usage defined as narcotic prescription filling at one year following cervical arthrodesis.
Based on preoperative opioid use, patients were identified as an OU (history of narcotic prescription filled within 3-months before surgery) or a NOU (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU, and trended for 1-year postoperatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at one year following ACF and PCF. Based on the model findings, a web-based interactive app was developed to estimate 1-year postoperative risk of using narcotics following cervical arthrodesis: https://www.neurosurgerycost.com/opioid/opioid_use
Overall, 87.4% patients (n=15,204) underwent ACF while 12.6% (n=2,187) underwent PCF. At one month following surgery, 47.7% NOU and 82% OUs had a filled opioid prescription. At three months, rates of prescription opioids declined significantly to 7.8% in NOUs versus 50.5% in OUs, while plateauing at 6-12 month postoperative period (NOU:5.7-6.7%; OU:44.9-46.9%). At one year, significantly higher narcotic prescription filling rates were observed in OUs compared to NOUs (45.3% vs. 6.3%;p<.001). Preoperative opioid use was a significant driver of 1-year narcotic use following ACF (OR:7.02;p<.001) and PCF (OR:6.98;p<.001) along with younger age (<=50 years), history of drug dependence and lower back pain.
Over 50% patients used opioids prior to cervical arthrodesis. Postoperative opioid-use fell dramatically during the first three months in NOU, but nearly half of the preop opioid users will remain on narcotics at one year postop. Our findings serve as a baseline in identifying patients at risk for chronic use and encourage discontinuation of opioids prior to cervical spinal surgery
This abstract does not discuss or include any applicable devices or drugs.
Details
- Title: Subtitle
- Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 74. Opioid utilization following cervical spine surgery: trends and factors associated with long-term use
- Creators
- Andrew J. Pugely - University of IowaPiyush Kalakoti - University of IowaNicholas A. Bedard - University of IowaNathan R Hendrickson - University of IowaComron Saifi - William Dyson, Philadelphia, PA, USARonald A. Lehman - Columbia UniversityK. Daniel Riew - New York City, NY, USA
- Resource Type
- Abstract
- Publication Details
- The spine journal, Vol.18(8), pp.S36-S36
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.spinee.2018.06.085
- ISSN
- 1529-9430
- eISSN
- 1878-1632
- Language
- English
- Date published
- 08/2018
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984305885602771
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