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.