Socioeconomic Impacts of Opioid Dependence on Spinal Decompression and Fusion at Any Level: Analysis of a Nationwide Database

Abstract

Abstract INTRODUCTION Increasing concern surrounds the impact of perioperative opioid dependence in spinal surgery candidates. Analysis of a national dataset following spinal decompression or fusion including all spinal levels in opioid-dependent patients has not been presented. METHODS Data were extracted from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) for adults in 2008 to 2014 who underwent spinal fusion (ICD-9 81.00-81.08), decompression (ICD-9 03.09) or revision (ICD-9 81.30-81.39). Patients with vertebral fracture, cancer and drug dependence other than opioids were excluded. Patients were divided into opioid-dependent (OD; ICD-9 304.0x) and nondependent cohorts. RESULTS In total, 491 919 patients underwent spinal fusion and met inclusion criteria, with 2021 (0.4%) OD patients. Demographically, OD patients were more likely Medicaid recipients (prevalence 91 per 10 000, P < .001) and had household incomes in the top quartile (50 per 10 000, P < .001). The OD cohort had higher rates of revision (11.8% vs 4.7%; P < .001), urgent admission (83.9% elective vs 90.8% elective; P < .001) and any complication (39.3% vs 18.7%; P < .001). Median total charges increased with OD [$117,400 (interquartile range $69,700-$197,100) vs $73,000 (interquartile range $46,000-$115,700); P < .001]. OD was associated with a longer length of stay [OR 2.49 (95% CI 2.33-2.64), P = .012], discharge to short-term hospital [OR 3.434 (95% CI 2.352-5.013), P < .001], and discharge to skilled nursing or intermediate care facility [OR 2.542 (95% CI 2.259-2.859); P < .001]. CONCLUSION Our analysis supports two potential hypotheses: that preoperative OD increases the cost and complications of spinal procedures; or, that more complex and expensive spinal operations heighten the likelihood of postoperative OD. Although chronological relationships between OD, onset of pain, and spinal operations cannot be determined using the NIS, expanded consideration of multidisciplinary opioid adjuncts in the perioperative period (such as intrathecal pumps, physical therapy, and behavioral psychology) may prove cost-effective, reduce incidence of OD, and improve outcomes.