Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 75. Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use

Piyush Kalakoti; Nicholas A. Bedard; Nathan R Hendrickson; Comron Saifi; Andrew J. Pugely

doi:10.1016/j.spinee.2018.06.086

Opioid therapy is one of the most effective and commonly practiced methods to control acute postoperative pain. Concerns relating to the overwhelming use of prescription narcotics including an inherent risk of abuse and tolerance has been a contentious issue. In patients undergoing lumbar spine surgery, limited or no data exist on potential risk factors for prolonged postoperative opioid use. In the context of national concern, it is pertinent to define epidemiological trends and risk factors of opioids use in spine patients for practice surveillance, preventive strategies, and patient counseling and welfare. To investigate trends in postoperative narcotic use amongst preoperative opioid users (OU) versus opioid-naïve (ON) patients, and identify factors associated with postoperative narcotic use at one year following lumbar arthrodesis. Retrospective, observational cohort study. A total of 26,553 patients (OU: 58.3%) registered in the Humana Inc. claims dataset (2007 through 2016Q3) that underwent either anterior (ALIF), posterior or transforaminal lumbar interbody fusions (P/TLIFs), postero-lateral fusion (PLF) or a combination of ALIF and PLF. Postoperative monthly opioid prescription filling rates up to one year in OUs and ON patients, and risk factors associated with prolonged opioid usage. Prolonged opioid use was defined as narcotic prescription filling at one year following lumbar arthrodesis. Using the Humana Inc. claims dataset (2007 through 2016Q3), we identified patients undergoing lumbar arthrodesis. Based on preoperative opioid use, patients were identified as an OU (history of the narcotic prescription filled within three months before surgery) or ON (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU and longitudinally tracked up to one year postoperatively for both OU and ON patients. Using log-binomial multivariable regression techniques, factors associated with opioid use at one year following lumbar arthrodesis. In an observational cohort study, we identified patients registered in the Humana Inc. claims dataset (2007 through 2016Q3) who underwent anterior (ALIF) or posterior/transforaminal lumbar interbody fusions (P/TLIFs), or postero-lateral fusion (PLF) or a combination of ALIF and PLF. Based on preoperative opioid use, patients were identified as an OU (history of the narcotic prescription filled within three months before surgery) or an ON (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU and trended for one year postoperatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at one year following lumbar surgery. Overall, 26,553 patients (OU: 58.3%) underwent lumbar surgery (ALIF:8.5%; P/TLIF:43.8%; PLF:41.5%; ALIF+PLF:6.2%). At one month following surgery, 60.2% NOU and 82.9% OUs had a filled opioid prescription. At three months, rates of prescription opioids declined significantly to 13.9% in NOUs versus 53.8% in OUs, while plateauing at 6-12-month postoperative period (NOU:8.4-9.6%; OU:42.1-45.3%). At one year, significantly higher narcotic prescription filling rates was observed in OUs compared to NOUs (42.4% vs. 8.6%; p<.001). Preoperative opioid use was a significant driver of one year narcotic use following ALIF (OR:7.1;p<.001) along with younger age[<=50 years] (OR:1.3;p=.05), male gender (OR:1.2;p=.05), history of drug dependence (OR:2.1;p=.038), lower back pain (OR:2.0;p=.022), and depression/anxiety disorder (OR:1.3;p<.001). Approximately one-third of patients used opioids prior to lumbar spine surgery. Postoperative opioid use fell dramatically during the first three months in ON patients, but nearly half of the preop opioid users will remain on narcotics at one year after primary lumbar arthrodesis. Our findings serve as a baseline in identifying patients at risk for chronic use and encourage discontinuation of opioids prior to lumbar spinal surgery owing to the risks associated with it. This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 75. Opioid utilization following lumbar arthrodesis: trends and factors associated with long-term use

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