50. Preoperative depression predicts prolonged opiate usage following lumbar spine fusion

Abstract

BACKGROUND CONTEXT Opioid overuse is a major epidemic in the United States that is associated with significant morbidity and mortality across various medical fields. Orthopedic surgery has come under scrutiny, as opioid prescriptions are indicted in many procedures postoperatively. Previous work has shown that depression and anxiety predict increased preoperative narcotic usage, and that a history of mental illness may predict longer opioid usage following elective spine surgery. However, there is no granular data on which specific psychiatric conditions are most associated with prolonged opioid intake following lumbar spine fusion. PURPOSE The purpose of this study is to investigate the relationship between preoperative depression or anxiety on the development of opioid use, dependence, and abuse within 90 and 180 days after discharge from a primary hospital admission for lumbar spine fusion. STUDY DESIGN/SETTING Retrospective cohort analysis using the 2010-2016 National Readmission Database with ICD-9 and ICD-10 codes. PATIENT SAMPLE A total of 596,568 patients who underwent lumbar spine fusion in the United States between 2010-2016. OUTCOME MEASURES Opioid use, abuse, or dependence within 90 and 180 days after discharge. METHODS Patients with either preoperative depression or anxiety were identified, and those who were categorized as opioid users or with history of opioid abuse/dependence on primary admission were excluded from analysis. This left 74,675 patients in the preoperative depression cohort and 22,197 patients in the preoperative anxiety cohort for analysis. Patients in both cohorts were then one-to-one propensity-matched for age and sex with patients who did not have depression or did not have anxiety. Statistical analyses were conducted in R, and Welch's two-sample t-tests were used to determine differences in opioid use, abuse, or dependence within 90 and 180 days after discharge. RESULTS Within 90 days, 5.53% of preoperatively depressed patients were either still using opioids or had opioid abuse/dependence designations on readmission compared to 4.31% in the nonpreoperatively depressed group (p=0.0019). At 180 days, 5.96% of preoperatively depressed patients were either still using opioids or had opioid abuse/dependence designations on readmission compared to 4.47% in the nonpreoperatively depressed group (p CONCLUSIONS Compared to an age and sex-matched nonpreoperatively depressed cohort, patients with preoperative depression were significantly more likely to have prolonged opioid usage (defined as opioid usage, abuse, or dependence in ICD-10 coding) at 90 and 180 days after discharge from a lumbar spine fusion procedure. Preoperative anxiety was not significantly associated with prolonged opioid consumption. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.