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

被引:6
作者
Gerlach, Erik B. [1 ]
Plantz, Mark A. [1 ]
Swiatek, Peter R. [1 ]
Wu, Scott A. [1 ]
Arpey, Nicholas [1 ]
Fei-Zhang, David [1 ]
Divi, Srikanth N. [1 ]
Hsu, Wellington K. [1 ]
Patel, Alpesh A. [1 ]
机构
[1] Northwestern Univ, Dept Orthopaed Surg, 676 N St Clair St,Suite 1350, Chicago, IL 60611 USA
关键词
opioid; spine surgery; healthcare utilization; healthcare resources; CHARLSON COMORBIDITY INDEX; LONG-TERM; RISK-FACTORS; PRESCRIPTION; PREDICTORS; FUSION;
D O I
10.1177/21925682221104731
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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 1 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 multilevel 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.
引用
收藏
页码:370 / 379
页数:10
相关论文
共 46 条
[41]   Factors associated with chronic opioid use after cervical spine surgery for degenerative conditions [J].
Wang, Marjorie C. ;
Lozen, Andrew M. ;
Laud, Purushottam W. ;
Nattinger, Ann B. ;
Krebs, Erin E. .
JOURNAL OF NEUROSURGERY-SPINE, 2020, 32 (01) :1-8
[42]  
Weir C. B., 2019, BMI Classification Percentile and Cut off Points
[43]   ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs [J].
Whitmore, Robert G. ;
Stephen, James H. ;
Vernick, Coleen ;
Campbell, Peter G. ;
Yadla, Sanjay ;
Ghobrial, George M. ;
Maltenfort, Mitchell G. ;
Ratliff, John K. .
SPINE JOURNAL, 2014, 14 (01) :31-38
[44]   From The Office Of The National Coordinator: The Strategy For Advancing The Exchange Of Health Information [J].
Williams, Claudia ;
Mostashari, Farzad ;
Mertz, Kory ;
Hogin, Emily ;
Atwal, Parmeeth .
HEALTH AFFAIRS, 2012, 31 (03) :527-536
[45]   Markers of abuse liability of short- vs long-acting opioids in chronic pain patients: A randomized cross-over trial [J].
Wilsey, Barth L. ;
Fishman, Scott ;
Li, Chin-Shang ;
Storment, Jeanna ;
Albanese, Anthony .
PHARMACOLOGY BIOCHEMISTRY AND BEHAVIOR, 2009, 94 (01) :98-107
[46]   ASA classification and perioperative variables as predictors of postoperative outcome [J].
Wolters, U ;
Wolf, T ;
Stutzer, H ;
Schroder, T .
BRITISH JOURNAL OF ANAESTHESIA, 1996, 77 (02) :217-222