83. Postoperative opioids and 1-year outcomes after spine surgery

Abstract

BACKGROUND CONTEXT Opioid use prior to spine surgery has been associated with worse patient-reported outcomes, complications, and sustained postoperative opioid use. However, studies thus far have not assessed the relationship between opioid use in the initial postoperative period with long-term clinical outcomes and chronic postoperative opioid use. PURPOSE Determine if longer duration and higher opioid dosage in the months following spine surgery is associated with 1-year patient-reported outcomes and chronic opioid use at 1 year. STUDY DESIGN/SETTING Using data from our prospective clinical spine registry linked with opioid prescription data from our state's prescription drug monitoring program, we conducted a longitudinal cohort study. PATIENT SAMPLE Patients undergoing elective lumbar or cervical spine surgery at a single academic center from January 2011 to February 2017, and living in the surgical institution's state. OUTCOME MEASURES Primary outcomes were meaningful improvements at 1 year (>30% from baseline) in axial and extremity pain (Numeric Rating Scale [NRS]), disability (Oswestry Disability Index [ODI] & Neck Disability Index [NDI]), quality of life (Euro-Qol 5D [EQ-5D]), satisfaction (North American Spine Society Satisfaction); and chronic opioid use at 1 year after surgery. METHODS The state database was queried to record the dosage (morphine milligram equivalents [MME]) and duration of every opioid prescription filled in the year before and after surgery to calculate the daily MME. The main exposure variables for this study were postoperative opioid use duration (classified as brief [ 60 MME/day) or low dosage. Multivariable logistic regression was used to identify associations between postoperative duration, and high-postoperative dosage with each outcome. Covariates were chosen a priori and included age, sex, race, smoking history, arthritis, anxiety, depression, insurance, symptom duration, ASA class, procedure, revision surgery, number of levels, preoperative pain and disability scores, and preoperative chronic opioid use. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were computed for the odds of a poor outcome associated with intermediate postoperative opioid use duration; and high-postoperative dosage. P-value RESULTS A total 2128 patients were included, with an overall 1-year satisfaction rate of 82%. Compared to patients with CONCLUSIONS In a risk-adjusted analysis of patients undergoing elective spine surgery, an active opioid prescription beyond 30 days was associated with significantly worse 1-year clinical outcomes and chronic opioid use. When considered in conjunction with the known dangers of opioids, our results can be used to develop postoperative opioid protocols to improve outcomes and minimize opioid dependence after spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.