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Opioid Dependence and Health Care Utilization After Decompression and Fusion in Patients With Adult Degenerative Scoliosis

Sharma, Mayur, MD, MCh; Ugiliweneza, Beatrice, PhD, MSPH; Sirdeshpande, Pooja, MD; Wang, Dengzhi, MS; Boakye, Maxwell, MD, MPH, MBA, FACS

doi: 10.1097/BRS.0000000000002794
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Study Design. Retrospective study.

Objective. To identify factors associated with opioid dependence after surgery for adult degenerative scoliosis (ADSc).

Summary of Background Data. Opioid epidemic is of prodigious concern throughout the United States.

Methods. Data was extracted using national MarketScan database (2000–2016). Opioid dependence was defined as continued opioid use or >10 opioid prescriptions for 1 year either before or 3 to 15 months after the procedure. Patients were segregated into four groups based on opioid dependence before and postsurgery: NDND (before nondependent who remain non-dependent), NDD (before nondependent who become dependent), DND (before dependent who become non-dependent) and DD (before dependent who remain dependent). Outcomes were discharge disposition, length of stay, complications, and healthcare resource utilization.

Results. Approximately, 35.82% (n = 268) of patients were identified to have opioid dependence before surgery and 28.34% (n = 212) were identified to have opioid dependence after surgery for ADSc. After surgical fusion for ADSc, patients were twice likely to become opioid independent than they were to become dependent (13.77% vs. 6.28%, OR: 2.191, 95% CI: 21.552–3.094; P < 0.0001). Before opioid dependence (RR: 14.841; 95% CI: 9.867, 22.323; P < 0.0001) was identified as a significant predictor of opioid dependence after surgery for ADSc. In our study, 57.9%, 6.28%, 13.77%, and 22.06% of patients were in groups NDND, NDD, DND, and DD respectively. DD and NDD were likely to incur 3.03 and 2.28 times respectively the overall costs compared with patients’ ingroup NDND (P < 0.0001), at 3 to 15 months postsurgery (median $21648 for NDD; $40,975 for DD; and $ 13571 for NDND groups).

Conclusion. Surgery for ADSc was not associated with increased likelihood of opioid dependence, especially in opioid naïve patients. Patients on regular opiate treatment before surgery were likely to remain on opiates after surgery. Patients who continued to be opioid dependent or become dependent after surgery incur significantly higher healthcare utilization at 3 and 3 to 15 months.

Level of Evidence: 4

Our study showed that surgery for ADSc was associated with increased likelihood of opioid independence. Prior opioid dependence was associated with increased risk of dependence. Patients who continued to be opioid dependent or become dependent following surgery incur significant health care utilization at 3 and 3-15 months following surgery.

Department of Neurosurgery, University of Louisville, Louisville, KY.

Address correspondence and reprint requests to Maxwell Boakye, MD, MPH, MBA, FACS, Professor, Department of Neurosurgery, University of Louisville, School of Medicine, 220 Abraham Flexner way, Louisville, KY 40202; E-mail: Maxwell.boakye@ulp.org

Received 23 May, 2018

Revised 26 June, 2018

Accepted 28 June, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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