Retrospective, economic analysis.
To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications
, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar
fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events
related to long-term postoperative opioid use.
Summary of Background Data.
Chronic opioid use is associated with poor outcomes
and dependence after spine surgery. Risk factors, complications
, readmissions, adverse events
, and costs associated with COT in patients undergoing lumbar
fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes
, identification of modifiable risk factors is important.
Commercial insurance data from 2007 to Q3–2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications
, ED visits, readmissions, 1-year adverse events
, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications
and adverse events
A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications
, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost
associated with increase resource use in these patients has been reported.
Preoperative COT is a modifiable risk factor for complications
, readmission, adverse events
, and increased costs after one- or two-level PLF.
Level of Evidence: 3