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Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Connolly, Joseph III DO, MPH*,†; Javed, Zulqarnain MBBS, MPH; Raji, Mukaila A. MD, MS*,†,‡,§; Chan, Winston MPH; Kuo, Yong-Fang PhD*,†,‡,§; Baillargeon, Jacques PhD*,†,§

doi: 10.1097/BRS.0000000000002133
Epidemiology
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Study Design. A population-based retrospective cohort study.

Objective. The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults.

Summary of Background Data. Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention.

Methods. Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study of 8377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long-term opioid use following lumbar fusion.

Results. After adjusting for covariates, the following factors were associated with an increased risk of long-term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR = 2.27, 95% CI = 1.48–3.49; Quartile 2 (23–72 days): OR = 5.94, 95% CI = 4.00–8.83; Quartile 3: (73–250 days) OR = 25.31, 95% CI = 17.26–37.10; Quartile 4 (≥250 days) OR = 219.95, 95% CI = 148.53–325.71)], refusion surgery (OR = 1.32, 95% CI = 1.02–1.72), and diagnosis of depression (OR = 1.43, 95% CI = 1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR = 0.79, 95% CI = 0.63–0.99).

Conclusion. These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.

Level of Evidence: 3

*U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, OH

Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX

Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX

§Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX.

Address correspondence and reprint requests to Jacques Baillargeon, PhD, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555. E-mail: jbaillar@utmb.edu

Received 1 September, 2016

Revised 15 December, 2016

Accepted 4 January, 2017

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country.

The National Institutes of Health (grant: R01DA039192-01A1) and the Clinical and Translational Science Award (UL1TR001439) from the National Center for Advancing Translational Sciences, National Institutes of Health funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy.

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