32. Preoperative high frequency opioid use dramatically increases complication rate within 90 days, increases two-year reoperation rates, and predisposes to opioid dependency following adult spinal deformity correction

Abstract

BACKGROUND CONTEXT With a heightened focus on prescription narcotic use in the United States, concern among surgeons has increased regarding preoperative and postoperative usage. However, the literature is scarce on outcomes of preoperative and prolonged opioid usage in adult spinal deformity (ASD) patients. PURPOSE Investigate effect of preoperative opioid usage on prolonged opioid use postoperatively and rates of reoperations. STUDY DESIGN/SETTING Retrospective review of the PearlDiver Database 2008-2013. PATIENT SAMPLE A total of 7,661 ASD patients. OUTCOME MEASURES Reoperations, 90-day complications, comorbidity burden, prolonged opioid usage METHODS ASD patients undergoing a fusion were isolated in the PearlDiver database between the years 2008-2013 using ICD-9 and CPT codes. Patients were stratified by prescription preoperative opioid use 3 months prior to surgery: (1) high frequency (>4 refills); (2) low frequency (1-3 refills); (3) opioid naive. Means comparison tests compared differences in demographics, complications, and reoperation rates. Logistic regression assessed the odds of complication and reoperations associated with preoperative frequency and prolonged opioid use (3 to 6 months postop), controlling for age, sex, and comorbidities. RESULTS A total of 7,661 ASD patients were isolated; 2,342 patients were high frequency preop opioid users, 2,247 low frequency preop opioid users, and 3,072 opioid naive. At BL, high frequency preop opioid users had higher rates of obesity, diabetes mellitus, CHF, COPD, hypertension, smoking and alcohol use (all p CONCLUSIONS Patients with high frequency preoperative opioid use are at increased risk of major complications within 90 days of surgery, prolonged use postoperatively, and increased risk of reoperations within two years. During preoperative risk assessment, providers should consider the effect of pre- and postoperative opioid usage on patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.