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Preoperative Chronic Opioid Therapy

A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion

Jain, Nikhil, MD; Phillips, Frank M., MD; Weaver, Tristan, MD; Khan, Safdar N., MD

doi: 10.1097/BRS.0000000000002609
CLINICAL CASE SERIES
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Study Design. Retrospective, economic analysis.

Objective. 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.

Methods. 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.

Results. 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.

Conclusion. 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

The Ohio State University Wexner Medical Center, Columbus, OH

Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Safdar N. Khan, MD, The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine Surgery, Associate Professor and Chief, Division of Spine Surgery, Department of Orthopaedics, Adjunct Associate Professor, Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute, Wexner Medical Center at The Ohio State University, 376 W. 10th Ave., 725 Prior Hall, Columbus, OH 43210; E-mail: safdar.khan@osumc.edu

Received 28 August, 2017

Revised 15 January, 2018

Accepted 12 February, 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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