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Spine J. 2019 Sep 16. pii: S1529-9430(19)30975-1. doi: 10.1016/j.spinee.2019.09.011. [Epub ahead of print]

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

Author information

1
Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA.
2
Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA, USA.
3
Department of Anesthesiology, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
4
Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD 21287, USA. Electronic address: ajain24@jhmi.edu.

Abstract

BACKGROUND CONTEXT:

Although prescribing opioid medication on a limited basis for postoperative pain control is common practice, few studies have focused on chronic opioid use following anterior cervical discectomy and fusion (ACDF).

PURPOSE:

To determine the prevalence of and risk factors for chronic opioid use following one and two-level ACDF for degenerative cervical pathology.

DESIGN:

Retrospective cohort.

PATIENT SAMPLE:

Using an insurance claims database, we identified patients aged 18-64 who underwent one or two-level primary ACDF from 2010 to 2015 for degenerative cervical pathology.

OUTCOME MEASURES:

Opioid prescription strength at various timepoints pre- and postoperatively and development of chronic postoperative opioid use.

METHODS:

Prescription opioid use was examined during the following periods: 90 days before 7 days preceding surgery (preoperative), 6 days preceding surgery to 90 days following surgery (perioperative) and from 91 to 365 days following surgery (postoperative). The primary outcome was chronic postoperative opioid use, defined as ≥120 days' supply of opioid prescriptions filled or ≥10 opioid prescriptions between 3 and 12 months postoperatively. Secondary outcomes were high-dose (>90 morphine milligram equivalents [MME]/day) and very high-dose (>200 MME/day) opioid prescriptions. A multivariate logistic model (area under the ROC curve 0.75, p<.001) was built to predict long-term opioid use.

RESULTS:

Among 28,813 patients who underwent ACDF, most were female (55%) and underwent single-level ACDF (68%), with mean age of 50±8.0 years. Fifty-two percent of patients filled an opioid prescription in the preoperative period, 95% of patients filled a prescription in the perioperative period, and 39% of patients filled a prescription in the postoperative period. High-dose and very high-dose opioid prescriptions in the perioperative period were identified in 45% and 24% of patients, respectively, whereas 17% met criteria for chronic postoperative opioid use. The odds of chronic opioid use were highest in the Western US (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3, 1.6). Duration of opioids prescribed was also highest in the Western US (median 111 days, interquartile range 11-336), p<.001. Factors associated with the highest risk for chronic opioid use were preoperative opioid use (OR 5.7, 95% CI 5.3, 56.2), drug abuse (OR 3.5, 95% CI 2.6, 4.5), depression (OR 1.7, 95% CI 1.6, 1.9), anxiety (OR 1.5, 95% CI 1.4, 1.6), and surgery in the western region of the United States (OR 1.5, 95% CI 1.3, 1.6).

CONCLUSIONS:

Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase risk for chronic opioid use following ACDF. Intervention focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care.

KEYWORDS:

Anterior cervical discectomy and fusion (ACDF); Cervical spine; Chronic opioid use; Opioid epidemic; Opioids; Spinal fusion

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