218. Preoperative opioid use is associated with increased readmission and reoperation rates following lumbar decompression, instrumentation and fusion

Abstract

BACKGROUND CONTEXT The prescription opioid epidemic and widespread use of narcotic medications has introduced new challenges when treating patients undergoing spine surgery. Recent studies in general surgery, spine and total joint arthroplasty literature demonstrate associations between preoperative opioid use and increased emergency department visits, readmission rates, revision rates and risk of developing chronic opioid dependence. Researchers estimate that 33-70% of patients undergoing spinal surgery use opioids preoperatively. Given the prevalence of preoperative opioid consumption among patients undergoing spine surgery, further research is needed to quantify and stratify perioperative risks in this patient population. PURPOSE The purpose of this study is to compare outcomes of primary one- or two-level lumbar decompression, instrumentation and fusion based on preoperative opioid consumption habits. STUDY DESIGN/SETTING A retrospective chart review was performed on patients who underwent one- to two-level posterior lumbar decompression, instrumentation and fusion from two spine surgeons at a single, tertiary referral center from 2013-2017. PATIENT SAMPLE Inclusion criteria included all patients who underwent a primary one- to two-level decompression (laminectomy or laminotomy) with posterior instrumentation, one- or two-level intertransverse arthrodesis (PLF), one- or two-level transforaminal lumbar interbody fusion (TLIF) or one- or two-level posterior lumbar interbody fusion (PLIF). Exclusion criteria included patients undergoing revision surgery, patients with concomitant malignancy or surgery for neoplastic disease, three- or more-level surgery, anterior or lateral (direct or oblique) interbody fusions, traumatic injuries (acute fractures or ligamentous instability) or other concurrent procedures. Patient opioid use was obtained from electronic medical records (Epic Systems Corporation, Verona, WI) including medication history and preoperative clinical documentation. Patients were divided into chronic opioid therapy (COT; >6 months), acute users (0-6 months) and opiate-naive based on their preoperative opioid usage. OUTCOME MEASURES Primary endpoints included readmission rates within 1 year and reoperation rates within 2 years. METHODS A retrospective chart review was conducted from 2013-2017 and patients who met the inclusion criteria were studied. Patients were divided into three groups based on their aforementioned preoperative opioid consumption status. Demographic information (age, BMI, sex and ethnicity), smoking status and primary outcome measures were identified and recorded based on documentation in the electronic medical record. RESULTS A total of 93 patients met the inclusion and exclusion criteria (57 PLF, 31 TLIF and 5 PLIF). Demographics characteristics were similar between all three groups. Thirty-three patients (35.5%) required COT, 31 patients (33.3%) utilized acute opioid therapy and 29 patients (31.2%) remained opioid naive. Current or former smokers were more likely to utilize acute or COT than never smokers (86% vs 59%; p=0.005). Readmission rates within 1 year for patients in the COT, acute and opioid naive groups were 50%, 41.7% and 8.3%, respectively (p=0.0115). Reoperation rates within 2 years for patients in the COT, acute and opioid naive groups were 54.2%, 33.3% and 12.5%, respectively (p = 0.033). CONCLUSIONS Long-term opiate use is associated with an increased risk for readmission within 1 year and revision within 2 years following a primary posterior decompression, instrumentation and fusion. Numerous data base studies have demonstrated similar, suboptimal outcomes for patients on preoperative opioid therapy compared to nonusers. This retrospective chart review corroborates the findings of these previous studies. Given the prevalence of narcotic usage in the US population, physicians should continue to educate acute or chronic opioid users about increased risk of readmission and revision associated with lumbar decompression and fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.