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Risk Factors for Prolonged Opioid Use Following Spine Surgery, and the Association with Surgical Intensity, Among Opioid-Naive Patients

Schoenfeld, Andrew J. MD, MSc1,a; Nwosu, Kenneth MD1,b; Jiang, Wei MS1,c; Yau, Allan L. BS2,d; Chaudhary, Muhammad Ali MD1,e; Scully, Rebecca E. MD1,f; Koehlmoos, Tracey PhD, MHA3,g; Kang, James D. MD1,h; Haider, Adil H. MD, MPH1,i

Journal of Bone & Joint Surgery - American Volume: 2 August 2017 - Volume 99 - Issue 15 - p 1247–1252
doi: 10.2106/JBJS.16.01075
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Background: There is a growing concern that the use of prescription opioids following surgical interventions, including spine surgery, may predispose patients to chronic opioid use and abuse. We sought to estimate the proportion of patients using opioids up to 1 year after discharge following common spinal surgical procedures and to identify factors associated with sustained opioid use.

Methods: This study utilized 2006 to 2014 data from TRICARE insurance claims obtained from the Military Health System Data Repository. Adults who underwent 1 of 4 common spinal surgical procedures (discectomy, decompression, lumbar posterolateral arthrodesis, or lumbar interbody arthrodesis) were identified. Patients with a history of opioid use in the 6 months preceding surgery were excluded. Posterolateral arthrodesis and interbody arthrodesis were considered procedures of high intensity, and discectomy and decompression, low intensity. Covariates included demographic factors, preoperative diagnoses, comorbidities, postoperative complications, and mental health disorders. Risk-adjusted Cox proportional hazard models were used to evaluate the time to opioid discontinuation.

Results: This study included 9,991 patients. Eighty-four percent filled at least 1 opioid prescription on discharge. At 30 days following discharge, 8% continued opioid use; at 3 months, 1% continued use; and at 6 months, 0.1%. In the adjusted analysis, the low-intensity surgical procedures were associated with a higher likelihood of discontinuing opioid use (discectomy: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.36 to 1.50; and decompression: HR = 1.34, 95% CI = 1.25 to 1.43). Depression (HR = 0.84, 95% CI = 0.77 to 0.90) was significantly associated with a decreased likelihood of discontinuing opioid use (p < 0.001).

Conclusions: By 6 months following discharge, nearly all patients had discontinued opioid use after spine surgery. As only 0.1% of the patients continued opioid use at 6 months following surgery, these results indicate that spine surgery among opioid-naive patients is not a major driver of long-term prescription opioid use. Socioeconomic status and pre-existing mental health disorders may be factors associated with sustained opioid use following spine surgery.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery (A.J.S., K.N., and J.D.K.), Department of Surgery (W.J., M.A.C., R.E.S., and A.H.H.), and Center for Surgery and Public Health (A.J.S., W.J., M.A.C., R.E.S., and A.H.H.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

2Tufts University School of Medicine, Boston, Massachusetts

3Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

E-mail address for A.J. Schoenfeld: ajschoen@neomed.edu

E-mail address for K. Nwosu: knwosu1@partners.org

E-mail address for W. Jiang: wjiang3@partners.org

E-mail address for A.L. Yau: allan.yau@tufts.edu

E-mail address for M.A. Chaudhary: mchaudhary@bwh.harvard.edu

E-mail address for R.E. Scully: rscully2@partners.org

E-mail address for T. Koehlmoos: tracey.koehlmoos@usuhs.edu

E-mail address for J.D. Kang: jdkang@partners.org

E-mail address for A.H. Haider: ahhaider@partners.org

Copyright 2017 by The Journal of Bone and Joint Surgery, Incorporated
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