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Opioid use persisted 1 year after cervical spine surgery in preoperative users

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Andrew J. Pugely

LOS ANGELES — Significantly greater rates of filling narcotic prescriptions after cervical spine surgery were seen in patients with a history of filling narcotic prescriptions vs. patients who filled no narcotic prescriptions prior to surgery, according to results presented said at the North American Spine Society Annual Meeting.

“Half of cervical spine surgery patients use opioids prior to surgery, but postoperative rates fell dramatically during the first 2 months” after surgery for prior, as well as non-prior opioid users, Andrew J. Pugely, MD, said.

However, 50% of patients with a prior history of filling narcotic prescriptions remained on opioids at 1 year postoperatively, he said.

Pugely and colleagues queried the Humana claims dataset by PearlDiver to analyze perioperative opioid use in about 14,800 patients with either commercial insurance or who were part of the Humana Medicare Advantage program who underwent posterior or anterior cervical fusion between 2007 and 2015; 52% of the patients were preoperative opioid users.

“In spine, we can see this is just a tremendously high number,” Pugely said.

Investigators defined preoperative opioid users as patients who had prescriptions filled within 3 months before surgery and non-opioid users as patients who had no recorded opioid prescriptions.

In terms of the results, “you can see at 3 months: those who used before, 50% were still filling prescriptions whereas the non-users, only 8%. That rate stayed fairly consistent up to 1 year, where 45% of people using opioids before surgery were still using them despite having their surgery whereas that number is only 6% in those [who] did not use opioids prior to surgery,” Pugely said.

The spine surgeons in Pugely’s practice have already used these data for educational purposes regarding the importance of weaning patients off of opioids prior to cervical spine surgery and aggressively tapering them off of opioids postoperatively, according to Pugely. – by Susan M. Rapp

Reference:

Pugely AJ, et al. Paper 74. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.

Disclosure: Pugely reports no relevant financial disclosures.