198. Chronic use of hydromorphone and oxycodone associated with reoperations after lumbar decompression and lumbar interbody fusions

Abstract

BACKGROUND CONTEXT Recent literature has demonstrated that preoperative opioid use is associated with both worse postoperative outcomes and increased postoperative opioid dependence after lumbar spine surgery. However, no studies have demonstrated a relationship between acute, subacute and chronic preoperative opioid use and reoperation on the lumbar 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 lumbar decompression (LD) and after lumbar posterior or transforaminal interbody fusion (PLIF/TLIF). STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 11,388 patients undergoing LD and 3,302 patients undergoing PLIF/TLIF without prior lumbar spine surgery. OUTCOME MEASURES Reoperation on the lumbar spine within 5 years postoperatively (decompression or fusion). 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. All patients were followed for 5 years postoperatively. RESULTS In the LD group a total of 532 patients (4.6%) underwent reoperation in 5 years postoperatively. Opioid naive patients had a 5-year reoperation rate of 4.2%, compared with 23.1%, 8.6%, 5.5%, 5.8%, and 0.0% with chronic preoperative use of hydromorphone, oxycodone, hydrocodone, tramadol and ER-oxycodone. These rates were higher than in patients with acute and subacute preoperative use. In multivariate analysis of group LD, controlling for multilevel surgery, age, gender and Charlson Comorbidity Index, chronic use of both oxycodone (odds ratio [OR] = 1.67, P CONCLUSIONS Both chronic use of the higher-potency opioid medications, oxycodone and hydromorphone, are associated with increased reoperations after lumbar decompression and lumbar interbody fusion procedures. The etiology of this association is not currently known and warrants further investigation. One explanation may be that opioid-induced hyperalgesia may result in difficult identification of preoperative pain generators and also chronic uncontrolled postoperative pain. Nevertheless, the information will valuable during patient counseling and when recommending preoperative opioid weaning. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.