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Risk Factors for Prolonged Postoperative Opioid Use After Spine Surgery

A Review of Dispensation Trends From a State-run Prescription Monitoring Program

Rosenthal, Brett D., MD; Suleiman, Linda I., MD; Kannan, Abhishek, MD; Edelstein, Adam I., MD; Hsu, Wellington K., MD; Patel, Alpesh A., MD, FACS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: January 01, 2019 - Volume 27 - Issue 1 - p 32–38
doi: 10.5435/JAAOS-D-17-00304
Research Article

Introduction: Opioid abuse and dependence have a detrimental effect on elective orthopaedic surgeries, yet pain control is an important predictor of postoperative satisfaction. We aimed at better defining risk factors for prolonged postoperative opioid requirements and risk factors for patients requiring higher doses of opioids after spine surgery.

Methods: The Illinois Prescription Monitoring Program was queried to analyze opioid dispensation patterns at 3 and 6 months postoperatively for adult patients who had spine surgery at a tertiary care hospital by a single surgeon over a 5-year period. Patients were divided into three groups: group 1 patients had opioid dispensed to them 3 and 6 months preoperatively, group 2 patients had opioid dispensed to them only at 3 months preoperatively, and group 3 patients did not have preoperative opioid prescriptions. Demographic characteristics, psychiatric history, smoking status, alcohol use, body mass index, surgical region, and presence of multiple prescribers were abstracted. Statistical analysis included multivariate modified Poisson regression, linear regression, and chi-squared testing when appropriate.

Results: Patients in group 1 were at significantly increased risk of continued opioid usage than those in group 2 (relative risk, 3.934; 95% confidence interval, 1.691 to 9.150; P = 0.0015) and those in group 3 (relative risk, 4.004; 95% confidence interval, 1.712 to 9.365; P = 0.0014) at 6 months postoperatively. Group 1 patients also had larger quantities of opioid dispensed to them relative to patients in group 2 or group 3 (P < 0.0001) at 6 months postoperatively.

Discussion: Use of opioid medications at 6 months preoperatively is a risk factor for continued usage and at higher doses 6 months postoperatively.

Level of Evidence: Level III: retrospective cohort study

From the Department of Orthopaedic Surgery, Northwestern University, Chicago, IL.

Correspondence to Dr. Rosenthal: brett.david.rosenthal@gmail.com

Dr. Edelstein or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Dr. Hsu or an immediate family member has received royalties from Stryker; is a member of a speakers' bureau or has made paid presentations on behalf of AONA; serves as a paid consultant to Allosource, AONA, CeramTec, Globus Medical, Graftys, Medtronic Sofamor Danek, Mirus; RTI, Stryker, and Xtant; has received research or institutional support from Medtronic; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the Cervical Spine Research Society, the Lumbar Spine Research Society, and the North American Spine Society. Dr. Patel or an immediate family member has received royalties from Amedica and Zimmer Biomet; serves as a paid consultant to Amedica, Pacira, and Zimmer Biomet; has stock or stock options held in Amedica, Cytonics, Nocimed, nView Medical, and Vital5; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Association, the AO Spine North America, the Cervical Spine Research Society, the International Society for the Advancement of Spine Surgery, the Lumbar Spine Research Society, and the North American Spine Society. None of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Rosenthal, Dr. Suleiman, and Dr. Kannan.

© 2019 by American Academy of Orthopaedic Surgeons
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