128. Subacute and chronic preoperative opioid use associated with reoperations in single-level ACDF patients without myelopathy

Abstract

BACKGROUND CONTEXT Recent literature has demonstrated that preoperative opioid use is associated with both worse postoperative outcomes and increased postoperative opioid dependence after anterior cervical discectomy and fusion (ACDF). However, no studies have demonstrated a relationship between acute, subacute, and chronic preoperative opioid use and reoperation on the cervical spine. This information would be valuable for counseling patients for preoperative opioid cessation. PURPOSE To demonstrate an association between preoperative use of five different opioid medications on reoperation after ACDF in patients without myelopathy. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE This study included 445 patients undergoing single-level ACDF without myelopathy. OUTCOME MEASURES Reoperation on the cervical spine 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 was used to determine the relative association of each medication on reoperations during the acute, subacute, and chronic periods. All patients were followed for 5 years postoperatively. RESULTS The most commonly used preoperative opioid was hydrocodone (50.3% acute use, 24.7% chronic use), followed by oxycodone (19.6% acute use, 6.7% chronic use), and tramadol (14.4% acute use, 5.4% chronic use). Hydromorphone and ER-oxycodone were only used in 1.8% and 0.4% of patients, respectively, and were excluded from further analyses. A total of 42 patients (9.4%) underwent reoperation within 5 years. At 5 years postoperatively patients who had acute, subacute, and chronic preoperative use of hydrocodone had reoperation rates of 9.4%, 14.8%, and 15.5%, respectively, compared to 4.7% in opioid naive patients (P 0.05). CONCLUSIONS Both subacute and chronic use of common opioid medications are associated with increased reoperations after single-level ACDF in non-myelopathic patients. While the reasons for this are unclear, chronic mu-receptor agonism is known to result in opioid-induced hyperalgesia. This may make identification of pain generators difficult in non-myelopathic patients or lead to chronic postoperative pain. This information is also critical when counseling patients on preoperative opioid cessation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.