155. What are the risk factors for continued opioid use in patients following spine surgery?

Abstract

BACKGROUND CONTEXT Although studies have explored acute opioid use within 30 days after surgery and chronic opioid use longer than 90 days after surgery, the impact of opioid use within the subacute phase of 31-90 days after surgery has not been studied. However, this subacute postoperative period has been identified as a potential predictor of chronic opioid use. PURPOSE This study aims to identify factors common in opioid-naïve patients who are at a high risk of opioid use during the subacute phase of 31-90 days after discharge. STUDY DESIGN/SETTING Retrospective analysis. PATIENT SAMPLE Adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019. OUTCOME MEASURES Opioid refills in the subacute postoperative period of 31-90 days following discharge. METHODS In this retrospective cohort study, the electronic medical record of adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019 were analyzed. Opioid refills in the subacute postoperative period of 31-90 days following discharge were the primary study outcome. RESULTS Of the study cohort consisting of 3,024 patients, 2,685 (89%) required inpatient opioids in the last 24 hours before discharge, 733 (26%) required an opioid refill 1-30 days after discharge, and 579 (19%) required opioid refill 31-90 days after discharge. Moreover, a postoperative opioid refill 1-30 days after discharge conferred the strongest risk of an opioid refill 31-90 days after discharge (OR 4.66, 95% CI 3.84-5.64). Other factors associated with the increased risk of an opioid refill 31-90 days after discharge were gabapentinoid use, discharge disposition to facilities other than home or self-care, reoperation, and female gender. Meanwhile, Asian American race was associated with the reduced risk. Those requiring opioid refills were noted to be younger, underwent longer surgeries, had extended inpatient hospital stays, required higher doses of inpatient opioids, and required higher doses of discharge opioid prescriptions for longer durations. CONCLUSIONS In opioid-naïve postoperative spine patients, opioid refills 1-30 days after discharge were strongly associated with an increased risk of opioid refills 31-90 days after discharge. Factors associated with opioid refill requirements also included longer surgeries and inpatient hospital stays as well as higher doses of inpatient opioids. Overall, this study enables physicians to identify patients at a higher risk of opioid use and to intervene early during the postoperative course. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Although studies have explored acute opioid use within 30 days after surgery and chronic opioid use longer than 90 days after surgery, the impact of opioid use within the subacute phase of 31-90 days after surgery has not been studied. However, this subacute postoperative period has been identified as a potential predictor of chronic opioid use. This study aims to identify factors common in opioid-naïve patients who are at a high risk of opioid use during the subacute phase of 31-90 days after discharge. Retrospective analysis. Adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019. Opioid refills in the subacute postoperative period of 31-90 days following discharge. In this retrospective cohort study, the electronic medical record of adult opioid-naïve patients who underwent spine surgeries at a quaternary medical care center from June 2012 to December 2019 were analyzed. Opioid refills in the subacute postoperative period of 31-90 days following discharge were the primary study outcome. Of the study cohort consisting of 3,024 patients, 2,685 (89%) required inpatient opioids in the last 24 hours before discharge, 733 (26%) required an opioid refill 1-30 days after discharge, and 579 (19%) required opioid refill 31-90 days after discharge. Moreover, a postoperative opioid refill 1-30 days after discharge conferred the strongest risk of an opioid refill 31-90 days after discharge (OR 4.66, 95% CI 3.84-5.64). Other factors associated with the increased risk of an opioid refill 31-90 days after discharge were gabapentinoid use, discharge disposition to facilities other than home or self-care, reoperation, and female gender. Meanwhile, Asian American race was associated with the reduced risk. Those requiring opioid refills were noted to be younger, underwent longer surgeries, had extended inpatient hospital stays, required higher doses of inpatient opioids, and required higher doses of discharge opioid prescriptions for longer durations. In opioid-naïve postoperative spine patients, opioid refills 1-30 days after discharge were strongly associated with an increased risk of opioid refills 31-90 days after discharge. Factors associated with opioid refill requirements also included longer surgeries and inpatient hospital stays as well as higher doses of inpatient opioids. Overall, this study enables physicians to identify patients at a higher risk of opioid use and to intervene early during the postoperative course.