119. Even acute preoperative opioid use before adult spinal deformity surgery associated with increased reoperations at five years

Abstract

BACKGROUND CONTEXT With the current prescription opioid crisis in the United States, extensive recent literature has demonstrated worse clinical outcomes and increased opioid dependence in patients taking preoperative opioids. However, no studies have demonstrated a link between preoperative opioids and reoperation. PURPOSE To demonstrate an association between preoperative opioid use and reoperation after adult spinal deformity (ASD) surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE This study included 160 patients undergoing posterior spinal fusion for adult spinal deformity. OUTCOME MEASURES Reoperation for revision decompression or fusion within 5 years postoperatively. METHODS Preoperative use of five opioid medications (tramadol, hydromorphone, oxycodone, hydromorphone, and extended-release (ER) oxycodone) were assessed and categorized as acute (within 3 months), subacute (acute use and use between 3-6 months), and chronic (subacute use and use prior to 6 months). Multivariate regression (MVA), controlling for age, gender, Charlson Comorbidity Index, and the number of levels fused, was used to determine the association of preoperative opioid use and reoperations at 5 years. All patients were followed for 5 years postoperatively. RESULTS A total of 160 patients were identified. Of those, 70 patients (44%) were opioid naive preoperatively, while 90 patients (56%), 56 patients (35%), and 51 patients (32%) demonstrated acute, subacute, and chronic preoperative opioid use respectively. The most commonly used preoperative opioids were hydrocodone (62 patients), oxycodone (27 patients), and tramadol (16 patients). The rate of reoperation in opioid naive patients at 5 years was 5.7%, compared with 25.6%, 28.6%, and 29.4% in patients with acute, subacute, and chronic preoperative use. In MVA, acute use was associated with increased reoperations (odds ratio: 6.00; P=0.02), while subacute (P=0.99) and chronic (0.82) were not significantly associated with reoperations. CONCLUSIONS Patients with acute preoperative opioid use had the greatest relative association with reoperations at 5 years. This may be due to opioid-induced hyperalgesia resulting in poorly identified preoperative pain generators or uncontrolled postoperative pain. While further investigation of the potential benefit of preoperative weaning programs is warranted, this information is valuable for counseling patients on preoperative opioid cessation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.