P147. Opioids and spinal cord stimulators: pre and postoperative opioid use pattern and factors associated with chronic postoperative opioid use

Abstract

BACKGROUND CONTEXT There remains a growing interest in finding alternative ways of treating chronic pain owing to the current opioid epidemic in the United States. Despite the increase in popularity of spinal cord stimulators (SCS) as a non-pharmacologic treatment for pain management, current spine literature lacks insight on patients' postoperative opioid use behavior. PURPOSE To compare the difference in pre- and postoperative oral prescription opioid usage in patients who underwent spinal cord stimulator placement from 2008-2015, and to characterize factors associated with chronic postoperative opioid use in the same patient cohort. STUDY DESIGN/SETTING Retrospective database analysis. PATIENT SAMPLE A private-payer insurance (Humana) records of patients who underwent a primary SCS placement from 2008-2014, searchable by International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. OUTCOME MEASURES Postoperative patient prescription opioid use and factors associated with chronic postoperative opioid use. METHODS A database of private-payer insurance records was queried to identify patients of all ages who underwent a primary SCS placement via a laminectomy (CPT-C3655) from 2008-2015. Our resulting patient cohort, after exclusion, was further stratified into four exclusive categories based on the number of preoperative prescription opioid refills within one year prior to SCS placement; Opioid-naive (no opioid refill), mild (1-3 refills), moderate (4-6 refills), chronic (greater 7 refills) subgroups. The same patient cohort was followed up to one year postoperatively and stratified. A multivariate logistic regression was employed to determine factors associated with chronic opioid usage postoperatively. RESULTS A total of 1,787 patients treated with open SCS placement were identified. A comparative analysis showed that while 57% of patients in our moderate opioid use subgroup either maintained the same number of refills or lower postoperatively, 43% of them had an increase in the number of opioid prescription refills postoperatively. Furthermore, 78% (691 out of 884 patients) of patients within the chronic opioid use subgroup remained within the same category post-SCS implantation. Our results showed that the 1-year mean pill burden for all patients was 889 pills per patient preoperatively versus 896 pills postoperatively. The most significant risk factors for chronic postoperative prescription opioid use were age less than 65 years (OR 1.42, 95% CI 1.12-1.93, P=0.005); chronic pain syndrome (OR 1.61, 95% CI 1.21-2.16, P=0.001); a history of tobacco use (OR 1.39, 95% CI 1.05-1.77, P=0.017); and mild (OR 2.26, 95% CI 1.36-3.84, P=0.002), moderate (OR 9.27, 95% CI 5.69-15.57, P CONCLUSIONS While SCS has been shown to be effective in the treatment of chronic pain in spine patients compared to CMM and reoperation, our stratification of patients based on their one year pre- and postoperative opioid use history paints a different picture. Using opioid refill history as a marker for patients' pain status, our results show that the effectiveness of SCS on patients with moderate to chronic preoperative opioid use history remain questionable. High proportions of these patients maintained the same number of opioid refills or increased their number of refills within 1 year of SCS placement. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.