Preoperative Chronic Opioid Therapy Negatively Impacts Long Term Outcomes Following Cervical Fusion Surgery.

Authors:
Piyush Kalakoti
Piyush Kalakoti
Rural Medical College
India
Nicholas A Bedard
Nicholas A Bedard
University of Iowa Hospitals and Clinics
United States
Nathan R Hendrickson
Nathan R Hendrickson
US Army Research Institute of Environmental Medicine
Andrew J Pugely
Andrew J Pugely
University of Iowa Hospitals and Clinics
United States

Spine (Phila Pa 1976) 2019 Apr 5. Epub 2019 Apr 5.

Spine Surgery, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242.

MINI: The study investigates the association between preoperative chronic opioid therapy on long-term outcomes (reoperations, ED visits, postoperative opioid use, and adverse events)in patients undergoing primary cervical spine arthrodesis using a commercial claims dataset.

Study Design: Retrospective, observational.

Objective: To define the impact of preoperative chronic opioid therapy (COT) on outcomes following cervical spine fusions.

Summary Of Background Data: Opioid therapy is a commonly practiced method to control acute post-operative pain. However, concerns exist relating to use of prescription opioids including inherent risk of abuse, tolerance, and inferior outcomes following major surgery.

Methods: A commercial dataset was queried from 2007-2015 for patients undergoing primary cervical spine arthrodesis[ICD-9 codes 81.01-81.03]. Primary outcome measures were 1-year and 2-year reoperation rates, emergency department (ED) visits, adverse events and prolonged postoperative opioid use. Secondary outcomes included short-term outcomes including 90-day complications (cardiac, renal, neurologic, infectious, etc). COT was defined as a history of opioid prescription filling within 3-months prior to surgery and was the primary exposure variable of interest. Generalized linear models investigated the association of preoperative COT on primary/secondary endpoints following risk-adjustment.

Results: Overall, 20,730 patients[51.3% female; 85.9% >50 years] underwent primary cervical spine arthrodesis. Of these, 10539[n = 50.8%] met criteria for COT. Postoperatively, 75.3% and 29.8% remained on opioids at 3 months and 1-year. Multivariable models identified an association between COT and an increased risk of 90-day ED visit (OR:1.25;p < 0.001), wound complications (OR:1.24;p = 0.036). At 1-year, COT was strongly associated with reoperations (OR:1.17;p = 0.043), ED visits (OR:1.31;p < 0.001), and adverse events including wound complications (OR:1.32;p < 0.001), infections (OR:1.34;p = 0.042), constipation (OR:1.11;p = 0.032), neurological complications (OR:1.44;p = 0.01), acute renal failure (OR:1.24;p = 0.004) and venous thromboembolism (OR:1.20;p = 0.008). At 2 years, COT remained a significant risk-factor for additional long-term negative outcomes such as reoperations including adjacent segment disc disease (OR:1.21;p = 0.005), ED visits (OR:1.32;p < 0.001), and other adverse events. Preoperative COT was associated with prolonged postoperative narcotic use at 3-month (OR:1.30;p < 0.001), 1-year (OR:5.17;p < 0.001) and at 2-year (OR:5.75;p < 0.001) after cervical arthrodesis.

Conclusions: Preoperative COT is a modifiable risk factor that is strongly associated with prolonged postoperative opioid use. Additionally, COT was associated with inferior short-term and long-term outcomes after cervical spine fusion.

Level Of Evidence: 3.

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Source
http://dx.doi.org/10.1097/BRS.0000000000003064DOI Listing
April 2019
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