Opioid Utilization Following Lumbar Arthrodesis

Trends and Factors Associated With Long-Term Use

Piyush Kalakoti, MD; Nathan R. Hendrickson, MD; Nicholas A. Bedard, MD; Andrew J. Pugely, MD

Spine. 2018;43(17):1208-1216.

Conclusion

Approximately one-third patients used opioids before lumbar arthrodesis. Postoperative opioid use fell dramatically during the first 3 months in ON patients, but nearly half of the pre-op OUs will remain on narcotics at 1 year after lumbar arthrodesis. Preoperative narcotic consumption, comorbidities, and drug/alcohol abuse were major drivers of prolonged postoperative narcotic use following lumbar arthrodesis. The identified risk factors and the proposed clinical utility app can be used as an adjunct to risk-stratification, patient counseling for encouraging discontinuation of presurgical narcotic use, and opioid weaning strategies. In addition, our data including the online calculator will serve as a baseline for future comparison as the national societies work to implement strategies for safer and more effective pain management control to mitigate opioid abuse.

1 2 3 4 5

Next Section

A portion of the work was submitted as an abstract to the 11th Annual meeting of the Lumbar Spine Research Society (LSRS), Chicago, IL, and was presented as a podium presentation.
The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.
No funds were received in support of this work.
No relevant financial activities outside the submitted work.

Table 1. Characteristics of Patients Undergoing Lumbar Arthrodesis in the Humana Inc Claims Database Between 2007 and 2014 Based Upon Preoperative Opioid Use
	ON n=11,065	OU n=15,488	Overall n=26,553	P
Age, yrs, n (%)
<50	566 (5.1)	1429 (9.2)	1995 (7.5)	<0.001
≥50	10,499 (94.9)	14059 (90.8)	24,558 (92.5)
Gender, n (%)
Female	9249 (59.7)	6375 (57.6)	15,624 (58.9)	0.001
Male	6239 (40.3)	4690 (42.4)	10,929 (41.1)
ALIF, n (%)	825 (7.5)	1437 (9.3)	2262 (8.5)	<0.001
P/TLIF, n (%)	4975 (45.0)	6653 (43.0)	11,628 (43.8)	0.001
PLF, n (%)	4685 (42.3)	6340 (40.9)	11,025 (41.5)	0.022
ALIF + PLF, n (%)	580 (5.2)	1058 (6.8)	1638 (6.2)	<0.001
Region
Midwest	2874 (26.0)	3350 (21.6)	6224 (23.4)	<0.001
Northeast	309 (2.8)	274 (1.8)	583 (2.2)	<0.001
South	6668 (60.2)	10212 (65.9)	16880 (63.6)	<0.001
West	1214 (11.0)	1652 (10.7)	2866 (10.8)	0.429
Long-term narcotic use (at 12 mo), n (%)	954 (8.6)	6565 (42.4)	7519 (28.3)	<0.001
Mean costs, US$	$39,514	$38,381	$38,947	0.521
Mean hospital stay	5.03	5.02	5.03	0.891

ON indicates opioid naive; OU, opioid user.

Table 2. Patients Filling Opioid Prescriptions Following Lumbar Arthrodesis
Postoperative Month	ON n=11,065		OU n=15,488		OU vs. NOU
	Opioid Prescription (n)	%	Opioid Prescription (n)	%	Risk Ratio	95% CI		P
	Opioid Prescription (n)	%	Opioid Prescription (n)	%	Risk Ratio	Lower	Upper	P
1	6664	60.2%	12,839	82.9	1.38	1.32	1.44	<0.001
2	2381	21.5%	9580	61.9	2.87	2.62	3.16	<0.001
3	1542	13.9%	8331	53.8	3.86	3.46	4.31	<0.001
4	1299	11.7%	7706	49.8	4.24	3.78	4.76	<0.001
5	1082	9.8%	7192	46.4	4.75	4.19	5.38	<0.001
6	1062	9.6%	7016	45.3	4.72	4.17	5.34	<0.001
7	1021	9.2%	6839	44.2	4.79	4.21	5.44	<0.001
8	944	8.5%	6701	43.3	5.07	4.47	5.75	<0.001
9	949	8.6%	6565	42.4	4.94	4.38	5.58	<0.001
10	931	8.4%	6581	42.5	5.05	4.47	5.71	<0.001
11	965	8.7%	6525	42.1	4.83	4.29	5.44	<0.001
12	954	8.6%	6565	42.4	4.92	4.35	5.55	<0.001

P value depicts differences in proportions of prescription filling across ON and OU for months following surgery.
CI indicates confidence interval; ON, opioid naive; OU, opioid user.

Table 3. Patients Filling Opioid Prescriptions Following Lumbar Arthrodesis
Postoperative Month	ALIF			PTLIF			PLF			ALIF + PLF
	ON	OU	Risk Ratio	ON	OU	Risk Ratio	ON	OU	Risk Ratio	ON	OU	Risk Ratio
	n=825	n=1437	Risk Ratio	n=4975	n=6653	Risk Ratio	n=4685	n=6340	Risk Ratio	n=580	n=1058	Risk Ratio
1	58.2%	85.7%	1.5	62.3%	83.7%	1.3	58.6%	81.2%	1.4	58.6%	83.6%	1.4
2	24.0%	70.1%	2.9	22.2%	61.6%	2.8	19.6%	59.2%	3.0	27.8%	68.5%	2.5
3	16.5%	63.0%	3.8	14.2%	53.0%	3.7	12.9%	51.3%	4.0	16.9%	61.1%	3.6
4	13.5%	59.1%	4.4	12.1%	48.6%	4.0	10.8%	47.8%	4.4	14.1%	56.3%	4.0
5	11.5%	53.7%	4.7	10.4%	45.6%	4.4	8.8%	44.4%	5.1	10.5%	54.2%	5.1
6	11.0%	51.8%	4.7	9.8%	44.3%	4.5	8.8%	43.8%	5.0	12.1%	51.7%	4.3
7	11.0%	50.4%	4.6	9.7%	43.9%	4.5	8.2%	42.0%	5.1	11.2%	50.3%	4.5
8	10.1%	49.7%	4.9	8.9%	42.3%	4.7	7.7%	41.8%	5.4	9.7%	49.6%	5.1
9	10.1%	49.3%	4.9	8.9%	41.2%	4.6	7.9%	41.1%	5.2	9.7%	48.3%	5.0
10	10.9%	47.6%	4.4	8.8%	42.5%	4.8	7.4%	40.3%	5.4	9.5%	48.4%	5.1
11	9.9%	48.0%	4.8	9.0%	42.1%	4.7	8.2%	39.9%	4.9	8.4%	47.6%	5.6
12	10.9%	48.6%	4.5	8.9%	42.3%	4.8	7.9%	40.1%	5.1	8.8%	48.2%	5.5

ALIF indicates anterior lumbar interbody fusion; ON, opioid naive; OU, opioid user; PLF, posterolateral fusion; PTLIF, posterior or transforaminal lumbar interbody fusion.

Table 4. Unadjusted (Univariable) Analysis Demonstrating Factors Associated with the Risk of Narcotic Use at 12 months Following Lumbar Arthrodesis Based on Surgical Technique
Associated Factors	ALIF				P/TLIF				PLF
	OR	95% CI		P	OR	95% CI		P	OR	95% CI		P
	OR	Upper	Lower	P	OR	Upper	Lower	P	OR	Upper	Lower	P
Age at surgery ≤ 50 yrs	1.46	1.23	1.73	<0.001	0.97	0.77	1.21	0.798	2.17	1.90	2.48	<0.001
Gender	1.09	0.96	1.24	0.186	0.96	0.84	1.10	0.542	0.95	0.88	1.02	0.152
Diabetes mellitus	0.96	0.84	1.10	0.590	1.25	1.10	1.43	0.001	1.04	0.97	1.12	0.244
Depression/Anxiety	1.78	1.52	2.08	<0.001	1.94	1.66	2.26	<0.001	1.98	1.81	2.17	<0.001
Osteoporosis	0.98	0.83	1.16	0.834	0.96	0.80	1.14	0.658	1.00	0.91	1.09	0.969
Fibromyalgia	1.41	1.22	1.62	<0.001	1.66	1.44	1.90	<0.001	1.55	1.43	1.67	<0.001
Morbid obesity	1.27	1.09	1.48	0.002	1.79	1.55	2.06	<0.001	1.33	1.22	1.44	<0.001
Lower back pain	1.90	1.43	2.57	<0.001	2.11	1.57	2.92	<0.001	1.41	1.21	1.63	<0.001
Motor deficits (plegia)	1.21	0.81	1.80	0.343	1.41	0.88	2.14	0.131	1.32	1.03	1.67	0.024
Bowel/Bladder dysfunction	1.09	0.93	1.27	0.298	1.62	1.39	1.88	<0.001	1.09	1.00	1.19	0.059
Alcohol abuse	2.02	1.35	3.04	0.001	2.24	1.50	3.24	<0.001	2.33	1.86	2.93	<0.001
Drug dependence	3.16	2.55	3.92	<0.001	3.01	2.46	3.66	<0.001	3.50	3.08	3.97	<0.001
Preop narcotic use (3-mo presurgery)	8.58	7.20	7.20	<0.001	5.32	4.44	6.44	<0.001	7.82	7.10	8.64	<0.001

ALIF indicates anterior lumbar interbody fusion; PLF, postero-lateral fusion; PTLIF, posterior or transforaminal lumbar interbody fusion.

Comments

processing....

Opioid Utilization Following Lumbar Arthrodesis

Trends and Factors Associated With Long-Term Use

Conclusion

Comments

Most Popular Articles

About

Membership

Apps

WebMD Network

Editions

Opioid Utilization Following Lumbar Arthrodesis

Trends and Factors Associated With Long-Term Use

Conclusion

Tables

Tables

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Key Points

Comments

Most Popular Articles

Email This

Feedback

Find Us On

About

Membership

Apps

WebMD Network

Editions