Regional Variation in Opioid Use After Lumbar Spine Surgery

Abstract

The aim of this study was to investigate regional variations in use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6 months before index surgery to 2 years after surgery was assessed. Of the 13,257 patients included in the study, 63.1% were from the South, 24.3% from the Midwest, 10.5% from the West, and 2.1% from the Northeast. Of patients, 57.8% had a history of opioid use before index surgery, of whom 64.4% were from the South and 23.0% from the Midwest. Over the 6-month preoperative period, 51.6 opioid pills were billed by opioid users monthly (Midwest, 52.7 pills/patient/month; Northeast, 64.9 pills/patient/month; South, 50.6 pills/patient/month; West, 52.2 pills/patient/month). During the 2-year period after surgery, an average of 33.6 opioid pills were billed by opioid users monthly (Midwest, 32.9 pills/patient/month; Northeast, 35.4 pills/patient/month; South, 33.9 pills/patient/month; West, 32.9 pills/patient/month). In a multivariate logistic regression analysis, receiving treatment in the South (odds ratio, 1.18; 95% confidence interval, 1.07-1.29) or West (odds ratio, 1.26; 95% confidence interval, 1.10-1.45) was independently associated with prolonged (>1 year) opioid use after index surgery. Our study suggests that regional variations may exist in the use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.