Post-surgical Prescription Opioid Use Among Opioid Users and the Opioid naive following Lumbar Spine Surgery

Introduction: Pre-operative opioid use is known to increase the likelihood of complications and inferior outcomes following spine surgery. We evaluated the association of opioid use at the time of surgery with the ability to cease use of opioid medications following the surgical procedure.

Methods: We queried 2006-2014 TRICARE insurance claims to identify adults who underwent lumbar interbody fusion, discectomy, decompression, or posterolateral fusion. The duration of pre-operative opioid use was categorized as: opioid naive (no exposure), acute exposure, exposed without sustained use, intermediate and chronic sustained use. Cox proportional-hazard models, that adjusted for demographic factors, pre-operative diagnoses, comorbidities, post-surgical complications and the type of procedure performed, were used to identify factors associated with opioid discontinuation following surgery.

Results: There were 37,022 patients included. Following surgery, 67% of patients using prior to surgery had discontinued opioid use at 30 days, while 86% had ceased use by 90-days. Among opioid naive patients, only 0.2% were still using opioids at 6-months, while 9% of pre-operative users continued use. Duration of pre-operative opioid use was the most important predictor of continued use following surgery. The ideal post-operative opioid prescription approximated 7 days.

Conclusion: The majority of patients who were using prescription opioids prior to surgery discontinued these medications post-operatively, while the event itself did not potentiate sustained use among the opioid naive. Duration of pre-operative use is the most important predictor of sustained use following surgery.