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.
| Original language | English (US) |
|---|---|
| Journal | Spine Journal |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- Anterior cervical discectomy and fusion (ACDF)
- Cervical spine
- Chronic opioid use
- Opioid epidemic
- Opioids
- Spinal fusion
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
- Clinical Neurology
Cite this
Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology. / Harris, Andrew B.; Marrache, Majd; Jami, Meghana; Raad, Micheal; Puvanesarajah, Varun; Hassanzadeh, Hamid; Lee, Sang H.; Skolasky, Richard; Bicket, Mark; Jain, Amit.
In: Spine Journal, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology
AU - Harris, Andrew B.
AU - Marrache, Majd
AU - Jami, Meghana
AU - Raad, Micheal
AU - Puvanesarajah, Varun
AU - Hassanzadeh, Hamid
AU - Lee, Sang H.
AU - Skolasky, Richard
AU - Bicket, Mark
AU - Jain, Amit
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Anterior cervical discectomy and fusion (ACDF)
KW - Cervical spine
KW - Chronic opioid use
KW - Opioid epidemic
KW - Opioids
KW - Spinal fusion
UR - http://www.scopus.com/inward/record.url?scp=85073823491&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073823491&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2019.09.011
DO - 10.1016/j.spinee.2019.09.011
M3 - Article
C2 - 31536805
AN - SCOPUS:85073823491
JO - Spine Journal
JF - Spine Journal
SN - 1529-9430
ER -