121. Effects of long-term opioid vs long-term NSAID use prior to lumbar spinal fusion

Abstract

BACKGROUND CONTEXT Chronic low back pain continues to be the leading cause of pain and disability in the United States. There are diverse therapeutic interventions to ameliorate the pain, ranging from pharmaceuticals to surgery. Many patients have been using NSAIDs and opioid analgesics to initially manage their pain, but long-term use of both have been associated with many deleterious effects. PURPOSE The current study compares the associated costs and postoperative complications following lumbar spinal fusion between patients who are long-term current users of opioid analgesics and patients who are long-term current users of NSAIDs. STUDY DESIGN/SETTING Retrospective cohort analysis using the 2010-2016 National Readmission Database. PATIENT SAMPLE Using the 2010-2016 National Readmission Database, we conducted a retrospective cohort analysis of 31,670 patients who received a lumbar spinal fusion surgery and were either diagnosed as long-term current users of opioid analgesics (n=7,663) or long-term current users of NSAIDs (n=24,007). Comorbidities and demographics were controlled between the two groups. OUTCOME MEASURES Associated costs and postoperative complications. METHODS We then collected all of the individuals that had a nonelective readmission (Opioids, 13.5%, n=1,034; NSAIDs, 9.6%, n=2,302) and analyzed associated costs and postoperative complications including surgical site/wound infection, UTI, postoperative pain, osteomyelitis, thromboembolism, sepsis, pneumonia, pseudarthrosis, novel lumbar pathology, nervous system complications, need for revision surgery, and death. Statistical analysis was conducted in R. Tukey multiple comparisons of means and Welch two sample t-test were used to compare complications and costs by surgical approach. RESULTS Long-term current users of opioid analgesics had significantly higher total charges at their primary lumbar fusion surgery ($174,321.59±$149,861.10) compared to the long-term current NSAID users ($112,095.00±$83,212.89) (p CONCLUSIONS Long-term current users of opioid analgesics had significantly higher costs and longer lengths of stay at the primary lumbar fusion, and significantly more postoperative complications with higher costs at the nonelective readmissions compared to the long-term NSAID users. Long-term NSAID users had significantly higher rates of UTI and thromboembolic events, whereas long-term opioid analgesic users had significantly higher rates of infection and death following lumbar spinal fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.