Chronic Opioid Use Following Anterior Cervical Discectomy and Fusion Surgery for Degenerative Cervical Pathology.

BACKGROUND CONTEXT: Although prescribing opioid medication on a limited basis for postoperative pain control is common practice, few studies have focused on chronic opioid use following anterior cervical discectomy and fusion (ACDF).

PURPOSE: To determine the prevalence of and risk factors for chronic opioid use following one and two-level ACDF for degenerative cervical pathology.

DESIGN: Retrospective cohort.

PATIENT SAMPLE: Using an insurance claims database, we identified patients aged 18-64 who underwent 1 or 2-level primary ACDF from 2010-2015 for degenerative cervical pathology.

OUTCOME MEASURES: Opioid prescription strength at various timepoints pre and postoperatively and development of chronic postoperative opioid use.

METHODS: Prescription opioid use was examined during the following periods: 90 days prior to 7 days preceding surgery (preoperative), 6 days preceding surgery to 90 days following surgery (perioperative) and from 91 to 365 days following surgery (postoperative). The primary outcome was chronic postoperative opioid use, defined as ≥ 120 days' supply of opioid prescriptions filled or ≥ 10 opioid prescriptions between months 3-12 postoperatively. Secondary outcomes were high-dose (>90 morphine milligram equivalents [MME]/day) and very high-dose (>200 MME/day) opioid prescriptions. A multivariate logistic model (AUC 0.75, p<0.001) was built to predict long-term opioid use.

RESULTS: Among 28,813 patients who underwent ACDF, most were female (55%) and underwent single-level ACDF (68%), with mean age of 50 ± 8.0 years. 52% of patients filled an opioid prescription in the preoperative period, 95% of patients filled a prescription in the perioperative period, and 39% of patients filled a prescription in the postoperative period. High-dose and very high-dose opioid prescriptions in the perioperative period were identified in 45% and 24% of patients, respectively, while 17% met criteria for chronic postoperative opioid use. The odds of chronic opioid use was highest in the Western US (OR 1.5, 95% CI: 1.3, 1.6). Duration of opioids prescribed was also highest in the Western US (median 111 days, IQR: 11-336), p<0.001. Factors associated with the highest risk for chronic opioid use were preoperative opioid use (OR 5.7, 95% CI: 5.3, 56.2), drug abuse (OR 3.5, 95% CI: 2.6, 4.5), depression (OR 1.7, 95% CI: 1.6, 1.9), anxiety (OR 1.5, 95% CI: 1.4, 1.6) and surgery in the western region of the United States (OR 1.5, 95% CI: 1.3, 1.6).

CONCLUSION: Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase risk for chronic opioid use following ACDF. Interventions focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care.