P59. Chronic preoperative opioid use is associated with higher perioperative resource utilization and adverse outcomes in adult spinal deformity patients

Abstract

BACKGROUND CONTEXT Prior to surgical consultation, spine patients are frequently started on opioid medications despite growing evidence discouraging this practice. Chronic opioid use has been reported in 15-30% of patients with degenerative pathology, but is poorly reported in the adult spinal deformity (ASD) population. PURPOSE This study quantifies the effect of preoperative opioid use on perioperative resource utilization and complications in ASD patients undergoing surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE Single center study of consecutive ASD patients. OUTCOME MEASURES Postoperative APS consultation, opioid requirements, PCA use, lidocaine and ketamine infusions, length of stay, and perioperative complications. METHODS Single center study of consecutive ASD patients. Patients were enrolled in a registry where demographics, HRQLs, surgical metrics and complications were recorded prospectively. Opioid use and resource utilization were collected through chart reviews. The impact of opioid use on perioperative resource utilization and complications was examined using multivariate regression accounting for confounders, or univariate analysis as appropriate. RESULTS A total of 139 patients were included, and divided into two groups based on preoperative opioid use: opioid naive n=52, and chronic opioid n=87. Among chronic opioid users, average preoperative opioid use was 122.5 MED, with 43% on doses >90 MED. The chronic opioid were more frequently revisions (68.3% vs 50%, p=0.039). The groups were similar in regards to baseline demographics, magnitude of deformity and surgical invasiveness. The chronic opioid group had more frequent involvement of the acute pain service (48.2% vs 7.84%, p=0.0001), and more frequent postoperative use of ketamine (36.4% vs 7.84%, p=0.0001) and lidocaine (14.1% vs 0%, p=0.005) infusions. Preoperative MED correlated with PCA duration (r=0.29, p=0.0018). The chronic opioid group had higher postoperative opioid requirements (POD1 MED 388.6 vs 178.83, p=0.004 – POD7 MED 198.92 vs 86.23, p=0.0066), and had a higher incidence of perioperative complications (IRR 1.53, p=0.029). Patients in the chronic opioid group showed a trend towards more frequent non-routine discharge (home hospital /rehabilitation / skilled nursing facility) (30.4% vs 16.6%, p=0.07). CONCLUSIONS Sixty-three percent of ASD patients were on chronic opioid analgesia prior to surgery. Opioid use was associated with increased perioperative resource utilization, higher rates of adverse events, and more frequent nonroutine discharge. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.