Opioid use prior to discectomy, fusion may increase complications in older patients
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CHICAGO — Prolonged opioid use prior to anterior cervical discectomy and fusion may increase the risk for multiple postoperative complications and opioid dependence among older patients, according to results presented here.
“We recommend referrals or consulting multidisciplinary teams pre[operatively] and postoperatively, pain management and addiction medication as they are available,” Michael Kim, BS, said in his presentation at the North American Spine Society Annual Meeting. “We recommend that future studies consider additional risk factors for postoperative dependence and potential pain management regimen changes prior to surgery.”
Using a large, nationally represented insurance claims database, Kim and colleagues categorized patients aged 65 years or older who underwent anterior cervical discectomy and fusion (ACDF) between 2010 and 2020 into either an opioid naïve group or a prolonged opioid prescription group. Outcomes included postoperative complications, prolonged postoperative opioid prescription, insurance reimbursement, readmission and revision.
“We defined ‘prolonged’ as 3 months continuously either pre[operatively] or postoperatively,” Kim said.
Among approximately 40,600 patients identified, Kim noted 10% required prolonged preoperative opioid prescription; 62% were opioid naïve and approximately 28% were excluded. Patients in the opioid prescription group and patients in the opioid naïve group had statistically significant differences in postoperative complications, according to Kim, with results identifying chronic preoperative opioid use as a risk factor for gastrointestinal and respiratory complications.
“We saw an increase in readmissions at 30 days and 1-year revisions,” Kim said. “We found no differences between infection, [myocardial infarction] or wound complications.”
Kim noted a statistically significant difference in postoperative opioid prescriptions between the two groups, with 19.7% of patients in the opioid naïve group and 74.2% of patients in the prolonged preoperative opioid group reporting at least 3 months of continuous opioid prescription after ACDF.
“We studied reimbursement at 3 and 6 months and found statistical significance between the groups at both time points, with that value increasing over time,” Kim said.
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Gardner CH, et al. Paper 15. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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