Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-nno postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race (P = 0.001), preoperative narcotic (P < 0.001) or anxiety/depression medication use (P = 0.002), and intraoperative long lumbar (P < 0.001) or thoracic spine surgery (P < 0.001). Lower patient income was also a risk factor for script renewal (P = 0.01). Script renewal at 12 months was associated with younger age (P = 0.006), preoperative narcotics use (P = 0.001), and >= 4 levels of lumbar fusion (P < 0.001). Renewals at 3-mo and 12-nno had no association with MME given during the hospital stay or with the usage of PCA (P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

Automated summary

This retrospective case control study aimed to determine risk factors associated with chronic opioid use after spine surgery. The results showed that black race, preoperative narcotics or anxiety/depression medication use, and long lumbar or thoracic spine surgery were associated with script renewal at 3 months postoperatively. Younger age, preoperative narcotics use, and lumbar fusion involving 4 or more levels were associated with script renewal at 12 months postoperatively. However, perioperative opioid utilization and PCA usage were not directly associated with script renewal.