The Association Between Chronicity of Preoperative Opioid Usage Between Patient Satisfaction, Return to Work, and Achieving ODI MCID up to 2 Years After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Abstract

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality improvement collaborative. Using the MSSIC database, we sought to identify the relationship between preoperative opioid usage and patient satisfaction, return to work, and achieving ODI MCID up to 2-yr after lumbar fusion. METHODS A total of 8693 lumbar fusion patients were analyzed. Patient satisfaction was measured by the NASS patient satisfaction index. Generalized estimating equations (GEE) models were constructed; variables tested include age, gender, race, PMH, and number of surgical levels. Preoperative opioid chronicity was defined as opioid naïve (no opioid usage), new opioid users (<6 wk), recent opioid users (6 wk-3 mo), frequent opioid users (3 mo-6 mo), and chronic opioid users (>6 mo). Comparisons were made to opioid naïve patients. RESULTS Chronic opioid users were less likely to be satisfied with their procedure at 90-d (OR 0.95, P < .001), 1-yr (OR 0.90, P < .001), and 2-yr (OR 0.87, P < .001) after surgery. New opioid users were more likely to achieve ODI MCID at 90-d (OR 1.25, P < .001), 1-yr (OR 1.15, P < .001), and 2-yr (OR 1.22, P < .002) postoperatively. Recent opioid users were more likely to achieve ODI MCID at 2 yr (OR 1.26, P < .001). Chronic opioid users were less likely to achieve ODI MCID at 90-d (OR 0.89, P < .001), 1-yr (OR 0.87, P = .002), and 2-yr (OR 0.82, P = .004). Chronic opioid users were also less likely to return to work at 90-d (OR 0.83, P < .001). CONCLUSION A multivariate analysis on preoperative opioid usage from a large, multicenter, prospective database on lumbar fusion patients was performed. We found that, as compared to opioid naïve patients, 2-yr postoperatively new opioid users (<6 wk) were more likely to have a favorable outcome, while chronic opioid users (>6 mo) were less likely to have a favorable outcome. Thus, preoperative opioid counseling is imperative to improve outcomes in spine surgery.