The Drivers of Persistent Opioid Use and Its Impact on Healthcare Utilization After Elective Spine Surgery

Abstract

Study Design Retrospective cohort study Objective The aim of this study was to determine the incidence of and risk factors for persistent opioid use after elective cervical and lumbar spine procedures and to quantify postoperative healthcare utilization in this patient population. Methods Patients were retrospectively identified who underwent elective spine surgery for either cervical or lumbar degenerative pathology between November 1, 2013, and September 30, 2018, at a single academic center. Patients were split into 2 cohorts, including patients with and without opioid use at 180-days postoperatively. Baseline patient demographics, underlying comorbidities, surgical variables, and preoperative/postoperative opioid use were assessed. Health resource utilization metrics within 1 year postoperatively (ie, imaging studies, emergency and urgent care visits, hospital readmissions, opioid prescriptions, etc.) were compared between these 2 groups. Results 583 patients met inclusion criteria, of which 16.6% had opioid persistence after surgery. Opioid persistence was associated with ASA score ≥3 (P = .004), diabetes ( P = .019), class I obesity ( P = .012), and an opioid prescription in the 60 days prior to surgery ( P = .006). Independent risk factors for opioid persistence assessed via multivariate regression included multi-level lumbar fusion (RR = 2.957), cervical central stenosis (RR = 2.761), and pre-operative opioid use (RR = 2.668). Opioid persistence was associated with higher rates of health care utilization, including more radiographs ( P < .001), computed tomography (CT) scans (.007), magnetic resonance imaging (MRI) studies ( P = .014), emergency department (ED) visits (.009), pain medicine referrals (P < .001), and spinal injections ( P = .003). Conclusions Opioid persistence is associated with higher rates of health care utilization within 1 year after elective spine surgery.