Limited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis.
To assess trends in post-operative narcotic use amongst preoperative opioid users (OU) versus non-opioid users (NOU), and identify factors associated with postoperative narcotic use at 1-year following cervical arthrodesis.
Retrospective, observational study.
17,391 patients (OU: 52.4%) registered in the Humana Inc. claims dataset that underwent anterior (ACF) or posterior cervical fusions (PCF) between 2007-2015.
Prolonged opioid usage defined as narcotic prescription filling at 1-year following cervical arthrodesis.
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 pre-operatively for OU, and trended for 1-year post-operatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at 1-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: http://neuro-risk.com/opiod-use/ or https://www.neurosurgerycost.com/opioid/opioid_use RESULTS: Overall, 87.4% patients (n=15,204) underwent ACF while 12.6% (n=2187) underwent PCF. At one-month following surgery, 47.7% NOU and 82% OUs had a filled opioid prescription. At 3-months, rates of prescription opioids declined significantly to 7.8% in NOUs vs 50.5% in OUs, while plateauing at 6-12 month postoperative period (NOU:5.7-6.7%; OU:44.9-46.9%). At 1-year, significantly higher narcotic prescription filling rates was observed in OUs compared to NOUs (45.3% vs 6.3%;p<0.001). Preoperative opioid use was a significant driver of 1-year narcotic use following ACF (OR:7.02;p<0.001) and PCF (OR:6.98;p<0.001) along with younger age(<=50 years), history of drug-dependence and lower back pain.
Over 50% patients used opioids prior to cervical arthrodesis. Postoperative opioid-use fell dramatically during the first 3-months in NOU, but nearly half of the pre-op opioid users will remain on narcotics at 1-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.
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