15. Impact of chronic preoperative opioid use on complications in elderly undergoing anterior cervical discectomy and fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> In recent decades, overuse and misuse of opioids has led to a national epidemic of opioid-related harm in the United States, and chronic neck and back pain are a leading source of opioid prescriptions. Recent data suggest that chronic preoperative opioid use is a risk factor for complications following spine surgery as well as for postoperative opioid dependence, both of which increase health care expenditures. However, none of these studies focus on an older adult population. Older adults have shown increasing rates of opioid use disorders in recent decades and typically suffer more comorbidities and complications, and incur higher health care costs than the general population. <h3>PURPOSE</h3> This study investigated the degree to which chronic preoperative opioid use is a risk factor for postoperative complications, opioid dependence and insurance reimbursement in an older population undergoing anterior cervical discectomy and fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> Retrospective database study. <h3>PATIENT SAMPLE</h3> Patients who underwent ACDF procedure. <h3>OUTCOME MEASURES</h3> Postoperative complications, postoperative opioid dependence, and insurance reimbursement. <h3>METHODS</h3> Adults over 65 years-old who underwent ACDF between 2010 and 2020 were identified using a national insurance database. Patients with infection, spinal trauma or malignancy were excluded. Chronic preoperative opioid use was defined as active opioid prescription in three or more consecutive months before surgery. Postoperative opioid dependence was defined similarly for three months postoperatively. Insurance reimbursement was measured postoperatively at 3-month and 6-month intervals. Bivariate logistic regression was used to analyze the association between chronic preoperative opioid use and postoperative complications, chronic preoperative opioid use and postoperative opioid dependence, and chronic preoperative opioid use and insurance reimbursement. <h3>RESULTS</h3> A total of 40,591 patients were included, of which 4,135 (10.2%) were prescribed chronic preoperative opioids and 25,300 (62.3%) were not prescribed any opioids preoperatively. Chronic preoperative opioid use was a risk factor for chronic opioid use postoperatively (OR=11.7, p<0.0001), readmission (OR=1.36, p<0.01), gastrointestinal complications (OR=1.36, p<0.001), and respiratory complications (OR=1.21, p<0.01). Mean reimbursements were higher for the chronic opioid group than the no opioids group at both the 3- and 6-month time points. <h3>CONCLUSIONS</h3> This study demonstrates that chronic opioid use preceding ACDF is a risk factor for multiple postoperative medical complications as well as postoperative opioid dependence in elderly patients. The data suggest that patients with chronic opioid use preoperatively are unlikely to stop using opioids after surgery. Future studies should consider additional risk factors for postoperative opioid dependence, particularly those which are common in the older population, and alternatives to opioids for pain management prior to surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.