Opioid weaning more than 2 months prior to spinal fusion may reduce long-term opioid use
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Published results showed patients who underwent spinal fusion had a significantly lower risk of long-term postoperative opioid use if their last opioid prescription was more than 2 months prior to surgery and less than a 14-day supply.
Using the Humana commercial insurance database, researchers categorized 17,643 patients who underwent primary cervical and lumbar/thoracolumbar fusions into groups based on the time between last opioid prescription of less than a 14-day supply and spinal fusion, including no gap, greater than a 2-month gap and greater than a 3-month gap. Researchers defined chronic preoperative opioid use as more than 5,000 total morphine equivalents in the year prior to spinal fusion. Researchers considered long-term postoperative opioid use as the primary outcome and used multiple variable logistic regression analyses to study the effect of the opioid gap on the risk of long-term postoperative opioid use.
Results showed 20.3% of patients had chronic preoperative opioid use, of whom 3% had a more than a 2-month gap and 1.1% had more than a 3-month gap between last opioid prescription and spinal fusion. Researchers noted patients with chronic preoperative opioid use were younger, had a higher comorbidity burden and were more likely to have a diagnosis of anxiety, depression, tobacco use disorder and IV drug use. Researchers found 53.8% of patients who had more than a 2-month gap between last opioid prescription and spinal fusion ceased to have long-term postoperative use vs. 27.8% of patients who did not have a gap between opioid use and spinal fusion. Logistic regression analysis showed an independent association between patients with more than a 2- and 3-month gap between last prescription and spinal fusion with a lower risk of long-term postoperative opioid use.
“We suggest a minimum duration of 2 months for preoperative opioid weaning and optimization in chronic opioid users before elective spine surgery to reduce the risk of long-term postoperative opioid use,” the authors wrote. “Although not directly studied here, the benefit of preoperative optimization of opioid tolerant patients is likely to extend beyond just the risk of long-term postoperative use. It will render pain control in the post-anesthesia unit and floor much more comfortable. There is potential to decrease risks such as postoperative ileus, infection, respiratory compromise, reduced mobility, etc.”
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In their article “Preoperative opioid weaning before major spinal fusion,” Nikhil Jain, MD, and colleagues provided a much-needed assessment of the impact of preoperative weaning from chronic opioid use prior to elective cervical and thoracolumbar spine surgery. Using a large cohort of 17,643 patients, they were able to demonstrate a significant reduction in the incidence of chronic postoperative use of opioids within the group who had demonstrated a probable discontinuation of high-level (greater than 5,000 total morphine equivalents/year) use within 2 to 3 months of surgery. Those patients had a 27% lower incidence of chronic postoperative opioid use when compared to the cohort who continued with their opioid utilization up to the date of surgery. Notably, chronic high-level opioid users without discontinuation prior to surgery demonstrated a 72% long-term postoperative opioid use rate, while those naïve to opioids or lower level in use (less than 5,000 total morphine equivalents/year) preoperatively only continued them 3.9% and 10.3% of the time.
The authors’ work further supports a broader effort to eliminate opioid use at least 2 months prior to elective spine surgeries. The potential benefit of discontinuing opioids within 2 months of, or closer to the planned surgery, was not specifically evaluated.
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