P67. Does a high postoperative opioid dose predict chronic use after ACDF?

Abstract

<h3>BACKGROUND CONTEXT</h3> Currently there is an incomplete understanding of the patient level risk factors for chronic opioid use after anterior cervical discectomy and fusion (ACDF). Postoperative opioid prescriptions in spine surgery have been found to commonly exceed the dose necessary for return to function and pain relief, however the direct relationship between postsurgical opioid dose and chronic opioid abuse has yet to be explored. <h3>PURPOSE</h3> To determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort Analysis. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent one- to four-level primary or revision ACDF for cervical spondylosis associated with radiculopathy and/or myelopathy at an academic center between 2016- 2019 were retrospectively identified. Patients lacking descriptive data or opioid utilization records or who had surgery performed for trauma, infection, or malignancy were excluded. <h3>OUTCOME MEASURES</h3> Postoperative opioid use prescription metrics: mean morphine equivalent (MME) opioid dose, duration of usage, and the number of prescriptions and pharmacies utilized. Preoperative opioid and benzodiazepine tolerance. Chronicity of postoperative opioid use. <h3>METHODS</h3> Pre- and postsurgical opioid and benzodiazepine prescriptions, including the postoperative peak MME and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Univariate analysis compared patient demographics and surgical factors across two binary groups of high vs low postoperative opioid dose (high: MME≥ 90, low: MME< 90) and chronic vs short-term opioid use (chronic: ≥120 days or >10 prescriptions). The relationship between chronic opioid use and patterns of immediate postoperative opioid use was evaluated. Binary logistic regressions were created to identify patient specific predictors of high opioid dose and chronic use. <h3>RESULTS</h3> A total of 385 patients met the inclusion criteria. Preoperative opioid tolerance and history of tobacco use were found to be associated with both high postoperative opioid dose and chronic postoperative usage. In addition, younger age correlated with receiving high dose prescriptions and obesity and preoperative benzodiazepine use were associated with chronic opioid use patterns. Chronicity of postoperative opioid use correlated meaningfully with immediate postoperative opioid use metrics including high single prescription dose, change in opioid prescribed, private pay scripatients, and greater than one prescriber and pharmacy. High postoperative opioid dose and preoperative opioid tolerance were identified as isolated predictors of chronic postsurgical opioid use on logistic regression. Regression also determined younger age, increased medical comorbidities, and opioid tolerance were significant predictors for high MME prescriptions. <h3>CONCLUSIONS</h3> High postoperative opioid dose was found to be a significant predictor of chronic opioid use after ACDF regardless of preoperative opioid tolerance. Because a multitude of factors increase patient opioid dose requirements after surgery, further research is required to determine if there exists a causal relationship between high postoperative opioid dosing and chronicity of use. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.