257. Persistent opioid use and resource utilization in spine surgery

Abstract

BACKGROUND CONTEXT Postoperative pain control commonly involves opioid use. From 2004 to 2015, there was a significant increase in the rate of spine surgery in the US, which raised concerns about the increase in persistent use of opioid drugs after spine surgery. PURPOSE The objectives of this study were to assess the influence of opioid use during spine surgery on post-surgery opioid use and impact of health care resource utilization. STUDY DESIGN/SETTING A retrospective cohort analysis was performed using deidentified administrative data and electronic health records from the University of Utah Health system. PATIENT SAMPLE Patients undergoing spine surgery in the hospital from January 2015 to June 2018 were included. OUTCOME MEASURES The primary outcome of this study was persistent opioid use defined by (1) opioid prescription within 30 days after the index discharge followed by opioid prescription between 31 – 180 days after the index discharge, and (2) opioid prescription within 90 days after the index discharge followed by opioid prescription(s) between 91 – 180 days. Secondary outcomes of this study were the proportion of patients reporting opioid-related adverse events (ORADE) and medical resource utilization such as number of hospital readmissions during the 180-day post-discharge period. METHODS Based on the level of exposure to opioids during the initial admission for the surgery, study cohort was grouped into two, High MME (ie, morphine milligram equivalent dose greater than median) and Low MME (ie, MME equal to or less than median). Patient characteristics and outcomes were summarized using descriptive statistics, and compared between the High MME and Low MME groups using bivariate comparison. The odds ratio of being a persistent opioid user for the High vs Low MME was adjusted for the baseline characteristics using a logistic regression model. Secondary outcomes were compared between the High MME and Low MME groups using bivariate analysis including student t-test, Wilcoxon Rank-sum test and Chi-square test. RESULTS Median (IQR) amount of opioid used during index procedure for High MME (N=1225) group and Low MME (N=1226) groups were 480 (371 – 668) mg and 136 (64 – 212) mg, respectively. The proportions of persistent opioid users defined by the 30-day cutoff were 42.4% of High MME and 36.8% of Low MME. When the 90-day cutoff was used, the respective proportions of persistent opioid users were 24.8% and 21.4%. The adjusted odds ratios (95% confidence interval) of being a persistent opioid user for High MME vs Low MME were 1.29 (1.09 - 1.53) for the 30-day cutoff and 1.27 (1.04 - 1.54) for the 90-day cutoff. The rate of ORADE over the 180-day post-discharge period was significantly higher among the High MME group compared to the rate from the Low MME group (31.8% vs 26.8%, p CONCLUSIONS An increase in opioid use during inpatient admission for spine surgery is associated with a higher rate of persistent opioid use, more frequent ORADE and a greater amount of resource utilization. Optimal pain management strategy that helps to reduce the opioid use during the surgery and inpatient postsurgical period could potentially decrease persistent opioid use and lower medical resource use and cost. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.