153. In opioid naïve patients undergoing thoracolumbar spinal fusions, smoking increases odds for postoperative opioid use disorder

Abstract

<h3>BACKGROUND CONTEXT</h3> Opioids are commonly used for management of pain following thoracolumbar spinal fusions. Numerous studies have identified patient and surgical risk factors for opioid dependence including preoperative opioid use, affective disorders, and invasiveness of surgery. However, the association of smoking and opioid use disorder, specifically in preoperative opioid naïve patients, has not been well characterized in spine literature. <h3>PURPOSE</h3> The purpose of this study is to characterize the risk for opioid use disorder (per DSM-V) after thoracolumbar spinal fusions among active smokers who were opioid naïve prior to surgery. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective analysis using the Mariner-53 database (administrative database containing 53 million participants). <h3>PATIENT SAMPLE</h3> We sampled patients (age > 18 years) who were opioid naïve preoperatively and underwent thoracolumbar fusions with and without a history of smoking, based on ICD-9 and ICD-10 diagnostic codes. <h3>OUTCOME MEASURES</h3> Opioid utilization and rates of opioid use disorder within 6 months of surgery were measured and compared. <h3>METHODS</h3> A total of 30,856 patients were identified, and exact 1:1 matching based on baseline patient demographics, procedure type (single vs multi-level fusion), affective disorders (depression, anxiety), social determinants of health and comorbidities were used to create two groups with identical covariates: smoking group (n=2,960) and nonsmoking group (n=2,960). <h3>RESULTS</h3> Baseline characteristics were similar between both groups. Postoperatively, opioid utilization rates at 6 months were similar between both groups (56.8% vs 57.4%, p=0.65). However, opioid naïve patients who were active smokers had higher odds of developing opioid use disorder postoperatively compared to nonsmokers (OR 4.18, 95% CI: 3.20 - 5.46). <h3>CONCLUSIONS</h3> Active smokers who are opioid naïve prior to thoracolumbar spinal fusion are 4 times more likely to develop opioid use disorder postoperatively compared to nonsmokers. Further multi-institutional prospective studies are needed to corroborate our findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.