Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 74. Opioid utilization following cervical spine surgery: trends and factors associated with long-term use

Abstract

BACKGROUND CONTEXT Limited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis. PURPOSE To assess trends in postoperative narcotic use amongst preoperative opioid users (OU) versus nonopioid users (NOU), and identify factors associated with postoperative narcotic use at one year following cervical arthrodesis. STUDY DESIGN/SETTING Retrospective, observational cohort study with longitudinal follow-up. PATIENT SAMPLE A total of 17,391 patients (OU: 52.4%) registered in the Humana Inc. claims dataset that underwent anterior (ACF) or posterior cervical fusions (PCF) between 2007 and 2015. OUTCOME MEASURES Prolonged opioid usage defined as narcotic prescription filling at one year following cervical arthrodesis. METHODS Based on preoperative opioid use, patients were identified as an OU (history of narcotic prescription filled within 3-months before surgery) or a NOU (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU, and trended for 1-year postoperatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at one year following ACF and PCF. Based on the model findings, a web-based interactive app was developed to estimate 1-year postoperative risk of using narcotics following cervical arthrodesis: https://www.neurosurgerycost.com/opioid/opioid_use RESULTS Overall, 87.4% patients (n=15,204) underwent ACF while 12.6% (n=2,187) underwent PCF. At one month following surgery, 47.7% NOU and 82% OUs had a filled opioid prescription. At three months, rates of prescription opioids declined significantly to 7.8% in NOUs versus 50.5% in OUs, while plateauing at 6-12 month postoperative period (NOU:5.7-6.7%; OU:44.9-46.9%). At one year, significantly higher narcotic prescription filling rates were observed in OUs compared to NOUs (45.3% vs. 6.3%;p CONCLUSIONS Over 50% patients used opioids prior to cervical arthrodesis. Postoperative opioid-use fell dramatically during the first three months in NOU, but nearly half of the preop opioid users will remain on narcotics at one year postop. Our findings serve as a baseline in identifying patients at risk for chronic use and encourage discontinuation of opioids prior to cervical spinal surgery FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.