253. Factors associated with chronic opioid use in preoperative opioid nonusers following adult spinal deformity surgery

Abstract

BACKGROUND CONTEXT Chronic opioid use is an emergent public health issue in the United States. Opioids are regularly prescribed to patients with adult spinal deformity (ASD) for postoperative pain. Therefore, the potential for chronic postoperative opioid use is a significant concern for patients undergoing surgery for ASD. It is important to patients, surgeons and policymakers to understand preoperative risk factors for prolonged opioid use in ASD patients who were not using opioids regularly prior to surgery. PURPOSE To demonstrate demographic and surgical factors associated with increased risk of chronic opioid use following surgery in ASD patients who were not regularly using opioids preoperatively. STUDY DESIGN/SETTING Retrospective review of a multicenter database. PATIENT SAMPLE A total of 760 ASD patients were identified in a multicenter database eligible for 2-year follow-up. Of these patients, 547 (72%) had complete baseline and 2-year responses to question 11 of the Scoliosis Research Society version 22r (SRS-22r), which allowed us to categorize patients into opioid users and non-opioid users. Of these, 251/547 patients (46%) were not using opioids regularly prior to surgery and included in our analysis. OUTCOME MEASURES Our primary outcome was chronic postoperative opioid use, and secondary outcome was patient satisfaction. METHODS Among patients who were not using opioids regularly prior to surgery, those reporting routine opioid use at 1 or 2-year follow-up were classified as CU (chronic user), while patients reporting no opioid use at both 1 and 2 years after surgery were classified as NC (no chronic use). Odds of CU vs NC were examined in relation to factors of interest, controlling for history of previous substance use disorder and baseline radiographic deformity. Satisfaction was assessed using the satisfaction domain of the SRS-22r. RESULTS Mean age of patients was 55 ± 17 years, 78% females. Overall, patients were using opioids until 3.2 ± 7.7 months postoperatively. A total of 176 patients (78%) were classified as NC and 51 (22%) CU. Factors associated with significantly increased odds of CU compared with NC included smoking (OR 3.44, 95% CI: 1.06 – 11.11; p=0.039), and each additional point worse on the back pain Numeric Rating Scale (NRS) (OR 1.24, 95% CI: 1.06 – 1.46; p=0.008) SRS-22r Activity domain (OR 1.99, 95% CI: 1.27 – 3.09; p=0.002) and SRS-22r Mental Health domain (OR 1.50, 95% CI: 1.06 – 2.11; p=0.022). Notable factors that were not significantly associated with chronic use included gender, C7-S1 sagittal vertical axis, prior spine surgery, elderly age, number of levels fused, 3-column osteotomy and at least one major complication (p>0.05). CU had worse SRS-22r satisfaction scores at 2 years compared with NC (4.33 ± .93 vs 3.80 ± 0.17, p=0.001). CONCLUSIONS The majority of opioid nonusers prior to ASD surgery will not become chronic users following surgery. Factors associated with chronic opioid use include smoking, higher baseline back pain, worse preoperative functional status, and worse mental health. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.