270. Patterns of opioid and other prescription medication use in lumbar surgery for spinal stenosis: a national claims database analysis

Abstract

BACKGROUND CONTEXT Low back pain is one of the most common chronic pain conditions and pain medication use is common among lumbar spine surgery patients. Patients undergoing spine surgery have an increased risk for chronic opioid dependence, which is associated with poorer outcomes and increased surgical costs. However, details of specific patterns of opioid and non-opioid pain medication use pre- and postsurgery and how these might relate to chronic use are not well understood. PURPOSE 1) Characterize patterns in prescription medication use before and after surgery for lumbar spinal stenosis; 2) Identify phenotypes of patients that have similar patterns of medication utilization. STUDY DESIGN/SETTING Retrospective analysis of national claims data (Marketscan® 2007—2015). PATIENT SAMPLE Adult patients undergoing primary single level lumbar surgery for a diagnosis of stenosis (n=17,466, age 58.5±12.8 years, 49.9% female). Patients were required to have continuous enrollment in a health plan providing outpatient pharmacy data for at least 2 years before and after surgery to track medication usage and costs. OUTCOME MEASURES Percentage of patients using each class of pain medication pre- and postoperatively, median morphine milligram equivalents (MME), and medication costs (2015 US$). METHODS We conducted a retrospective analysis of national claims data (Marketscan® 2007—2015)Adult patients undergoing primary single level lumbar surgery for a diagnosis of stenosis (n=17,466, age 58.5±12.8 years, 49.9% female). Patients were required to have continuous enrollment in a health plan providing outpatient pharmacy data for at least 2 years before and after surgery to track medication usage and costs. RESULTS Median annual prescription costs were $1,810 (IQR: $410, $4,423) 2 years prior to surgery and $2,125 (IQR: $604, $4,908) in the year prior to surgery. Postoperatively, annual prescription costs were $2,021 (IQR: $553, $4,826) in the first year and $1,656 (IQR: $286, $4,697) in the second year. The percentage of patients taking opioids prior to surgery increased dramatically leading up to surgery and remained elevated 2 years postsurgery. To a lesser degree, the percentage of patients taking anxiolytics, muscle relaxants, and anticonvulsants also increased prior to surgery and remained elevated 2 years post-surgery. 84.3% of patients used opioids in the two years preoperatively, while 95.2% used opioids in the 2 years postoperatively. Of all prescriptions filed, the 3 most common opioid medications were hydrocodone bitartrate-acetaminophen (54.3%), oxycodone HCl-acetaminophen (15.6%), and oxycodone-HCl (5.5%). While the number of users increased dramatically leading up to surgery, in opioid users, the median dose of opioids taken remained relatively stable. However, the median MME taken per patient per month remained elevated 2 years after surgery (720 MME/month 2 years postop vs 492 MME 2 years preop). CONCLUSIONS The proportion of patients taking prescription drugs increased in the months leading up to spine surgery, and in many cases remained elevated 2 years postsurgery. In particular, the proportion of patients using opioids never dropped to levels observed 2 years preoperatively and opioid users were taking greater quantities of opioids 2 years postoperatively than they were 2 years preoperatively. Spine surgery has a lasting impact on medication use patterns. However, we hope that with greater attention paid to medication use, better progress can be made in the future to reverse these patterns. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.