142. Impact of preoperative chronic opioid therapy on long-term outcomes, reoperations, complications and resource utilization after lumbar arthrodesis

Abstract

BACKGROUND CONTEXT Opioid therapy is effective in controlling acute postoperative pain. However, the potential for abuse has been a national concern. Recent clinical trials have questioned the benefit-risk ratio of chronic opioid therapy (COT) in musculoskeletal disorders. PURPOSE The purpose of our study is to elucidate the association of preoperative COT on mid-term to long-term outcomes after primary lumbar arthrodesis. STUDY DESIGN/SETTING Retrospective, observational cohort study. PATIENT SAMPLE A total of 28,795 patients registered with the Humana Inc. claims dataset (accessed via the Pearl Diver Research Program) who underwent primary lumbar spine fusion. OUTCOME MEASURES Ninety-day (mid-term), 1-year and 2-year (long-term) reoperation rates, resource utilization [ED visits, epidural steroid and facet-joint injections], complications [new constipation, acute renal failure (ARF), venous thromboembolic events, infections, postoperative wound, neurologic, respiratory and cardiac complications] and postoperative opioid use across patients on COT versus opioid-naive (ON) users. METHODS COT was defined as patients with an active opioid prescription three months prior to their initial lumbar fusion. Multivariable generalized linear models with risk-adjustment investigated the impact of preoperative COT on outcome measures, RESULTS Patients undergoing primary lumbar fusion registered with the Humana claims dataset were predominantly women (59%) and aged >50 years (91.4%) with an average cost/claim of $28,631.66. Approximately, 57% of patients were on preoperative COT prior to undergoing lumbar fusion surgery. Multivariable regression models identified COT to be associated with increased risk of 90-day ED visits (OR:1.18; p CONCLUSIONS Preoperative COT was strongly associated with prolonged postoperative opioid use. The study highlights COT to be associated with inferior mid-term and long-term outcomes and increased resource utilization including ED visits and other pain alleviation modalities after lumbar arthrodesis. Implementing a multidisciplinary opioid-tapering protocol prior to spine surgery can aid in optimizing outcomes and atypical postoperative opioid requirements. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.