General Session: Innovative Technologies I - Hall F

Presented by: N. Jain

Author(s):

N. Jain(1), F. Phillips(2), T. Weaver(1), S. Khan(1)

(1) Ohio State University Wexner Medical Center, Columbus, OH, United States
(2) Midwest Orthopaedics at Rush, Chicago, IL, United States

Abstract

Introduction: Chronic opioid use is associated with poor clinical outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with chronic opioid therapy (COT) in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors will be important. Our objective was to study patient profile associated with pre-operative COT, and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary 1-2 level posterior lumbar fusion (PLF) for degenerative disease of the spine. We also evaluated associated costs as well as risk factors and adverse events related to long term post-operative opioid use.

Methods: Commercial insurance data from 2007 to Q3-2015 was used to study pre-operative opioid use in patients undergoing primary 1-2 level PLF for degenerative spine pathology. Patients with opioid prescriptions for >6 months before surgery were considered as having pre-operative COT. Patients with continued opioid use till one-year after surgery were considered as long-term users. 90-day complications, ED visits, readmissions, one-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study pre-operative COT patient profile, and study opioid use as a risk factor for complications and adverse events.

Results: 24,610 patients with a mean age of 65.6±11.5 years were included. 5,500 (22.3%) patients had documented opioid use for >6 months before surgery. After adjusting for confounders, we found that pre-operative COT was associated with a higher risk of 90-day wound complications (OR 1.19, 95% CI: 1.05-1.35, p=0.005), pain diagnoses (OR 1.1, 95% CI: 1.02-1.19, p=0.009), ED visits (1.31, 95% CI: 1.15-1.49, p< 0.001), and readmission for all complications within 90-days (OR 1.15, 95% CI:1.02-1.29, p=0.02) as compared to patients who did not have pre-operative COT. This risk was higher when analyzing readmissions for lumbar spine related pain diagnoses (OR 1.80, 95% CI:1.24-2.57, p=0.001). Patients with pre-operative COT were more likely to have post-operative long-term opioid use (OR 8.08, 95% CI: 7.40-8.80, p< 0.001). 13,245 (54%) patients had opioid prescriptions for at-least a year after surgery. Long-term opioid users had an increased utilization of lumbo-sacral epidural and facet joint injections (OR 2.18, 95% CI: 1.96-2.44, p< 0.001), and had a higher likelihood of revision fusion within one-year (OR 1.33, 95% CI:1.14-1.55, p< 0.001). In addition, they had an increased incidence of new onset constipation (OR 1.18, 95% CI: 1.09-1.29, p< 0.001). The cost associated with increase resource use in these patients have been reported.

Conclusion: Pre-operative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after 1-2 level PLF.