P127. Fibromyalgia increases postoperative use and misuse following single-level thoracolumbar interbody fusions (TLIF)

Abstract

BACKGROUND CONTEXT Fibromyalgia is a disabling disease (population prevalence up to 6.6%) characterized by chronic generalized body aches that is refractory to traditional pain therapy. Patients with fibromyalgia undergoing spine surgery are a uniquely challenging population given the high-risk for chronic opioid use. However, the impact of fibromyalgia on postoperative opioid use and dependance following spine surgery has not been well characterized in literature. PURPOSE The aim of this study is to characterize the risk for opioid use disorder after single-level TLIF among patients with fibromyalgia who were opioid naïve prior to surgery. STUDY DESIGN/SETTING This was a retrospective analysis using the Mariner-53 database (administrative database containing 53 million lives). PATIENT SAMPLE Based on ICD-9 and ICD-10 diagnostic codes, patients (age>18 years) with a history of fibromyalgia who were opioid naïve preoperatively and underwent single-level TLIF were compared to a randomly selected sample of patients without fibromyalgia who underwent single-level TLIF. OUTCOME MEASURES Opioid utilization and odds for developing opioid use disorder within 6 months of surgery were compared between both groups. METHODS Exact 1:1 matching based on baseline patient demographics, smoking history, affective disorders (depression, anxiety) and social determinants of health were used to create two groups with identical covariates: fibromyalgia (n=1,191) and non-fibromyalgia group (n=1,191). RESULTS Both groups were balanced at baseline. At 6 months, opioid naïve patients with fibromyalgia had higher odds of developing opioid use disorder postoperatively compared to those without fibromyalgia (OR: 1.73, 95%CI: 1.17-2.56). In addition, the odds of opioid use, any dosage, within 6 months of single-level TLIF among patients with fibromyalgia was 2.11 times greater than patients without fibromyalgia (95% CI: 1.79-2.49, p<0.005). CONCLUSIONS This study suggests that patients with fibromyalgia who are opioid naïve prior to single-level TLIF have 73% higher odds of developing opioid use disorder postoperatively compared to patients without fibromyalgia. Postoperative opioid utilization within 6 months was also higher in patients with fibromyalgia. Further prospective multi-center studies are needed to corroborate our findings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Fibromyalgia is a disabling disease (population prevalence up to 6.6%) characterized by chronic generalized body aches that is refractory to traditional pain therapy. Patients with fibromyalgia undergoing spine surgery are a uniquely challenging population given the high-risk for chronic opioid use. However, the impact of fibromyalgia on postoperative opioid use and dependance following spine surgery has not been well characterized in literature. The aim of this study is to characterize the risk for opioid use disorder after single-level TLIF among patients with fibromyalgia who were opioid naïve prior to surgery. This was a retrospective analysis using the Mariner-53 database (administrative database containing 53 million lives). Based on ICD-9 and ICD-10 diagnostic codes, patients (age>18 years) with a history of fibromyalgia who were opioid naïve preoperatively and underwent single-level TLIF were compared to a randomly selected sample of patients without fibromyalgia who underwent single-level TLIF. Opioid utilization and odds for developing opioid use disorder within 6 months of surgery were compared between both groups. Exact 1:1 matching based on baseline patient demographics, smoking history, affective disorders (depression, anxiety) and social determinants of health were used to create two groups with identical covariates: fibromyalgia (n=1,191) and non-fibromyalgia group (n=1,191). Both groups were balanced at baseline. At 6 months, opioid naïve patients with fibromyalgia had higher odds of developing opioid use disorder postoperatively compared to those without fibromyalgia (OR: 1.73, 95%CI: 1.17-2.56). In addition, the odds of opioid use, any dosage, within 6 months of single-level TLIF among patients with fibromyalgia was 2.11 times greater than patients without fibromyalgia (95% CI: 1.79-2.49, p<0.005). This study suggests that patients with fibromyalgia who are opioid naïve prior to single-level TLIF have 73% higher odds of developing opioid use disorder postoperatively compared to patients without fibromyalgia. Postoperative opioid utilization within 6 months was also higher in patients with fibromyalgia. Further prospective multi-center studies are needed to corroborate our findings.