Associations with daily opioid use during hospitalization following lumbar fusion: A contemporary cohort study

Abstract

BackgroundPredicting opioid use after lumbar spine fusion remains a challenge. The aim of this study was to identify clinical and demographic parameters that could be associated with opioid use trends during hospitalization after lumbar spine fusion. MethodsA cohort study of prospective data for all lumbar fusions performed by single surgeon for an 18-month period from 2019 to 2020 was conducted. Univariable and multivariable linear regression analyses were used to assess associations. ResultsAmongst the overall cohort of 136 lumbar fusion patients, the mean age was 66.1 ± 10 years, there was an average of 1.7 ± levels treated. Overall, mean opioid use for total stay was 276 ± 360 morphine milligram equivalents (MME), with the greatest amount on postoperative day 1 (POD1) with 81.6 ± 86 MME. Multivariable linear analysis identified older age (−9.9 MME/year; P < 0.01), male gender (−130 MME; P = 0.03) and thoracolumbar interfascial plane (TLIP) block (−144 MME; P = 0.02) all independently were associated with significantly lower opioid use during overall hospitalization. Older age (P < 0.01), POD1 pain in back (P < 0.01), and TLIP use (P < 0.02) also independently were associated significantly lower opioid use on POD1. ConclusionsSignificant reductions in opioid use during hospitalization after lumbar spine fusion were associated with patients that were older, male, and had a TLIP block used. The maximum absolute opioid use was on POD1. We were able to quantify these trends on a daily gradient, which lays the conceptual groundwork to develop personalized algorithms which can model opioid use during hospitalization prior to surgery.