Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery.

Study Design: Retrospective case control.

Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery.

Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses.

Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( = 0.001), preoperative narcotic ( < 0.001) or anxiety/depression medication use ( = 0.002), and intraoperative long lumbar ( < 0.001) or thoracic spine surgery ( < 0.001). Lower patient income was also a risk factor for script renewal ( = 0.01). Script renewal at 12 months was associated with younger age ( = 0.006), preoperative narcotics use ( = 0.001), and ≥4 levels of lumbar fusion ( < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( > 0.05).

Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.