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Preoperative Opioid Weaning Before Major Spinal Fusion: Simulated Data, Real-World Insights.

Abstract：

STUDY DESIGN:Retrospective cohort. OBJECTIVE:To identify gaps in opioid prescription immediately prior to spinal fusion and to study the effect of such simulated "opioid weaning/elimination" on risk of long-term postoperative opioid use. SUMMARY OF BACKGROUND DATA:Numerous studies have described preoperative opioid duration and dose thresholds associated with sustained postoperative opioid use. However, the benefit and duration of preoperative opioid weaning before spinal fusion has not been elaborated. METHODS:Humana commercial insurance data (2007-Q1 2017) was used to study primary cervical and lumbar/thoracolumbar fusions. More than 5000 total morphine equivalents in the year before spinal fusion were classified as chronic preoperative opioid use. Based on time between last opioid prescription (<14-days' supply) and spinal fusion, chronic opioid users were divided as; no gap, >2-months gap (2G) and >3-months gap (3G). Primary outcome measure was long-term postoperative opioid use (>5000 total morphine equivalents between 3 and 12-mo postoperatively). The effect of "opioid gap" on risk of long-term postoperative opioid use was studied using multiple-variable logistic regression analyses. RESULTS:17,643 patients were included, of whom 3590 (20.3%) had chronic preoperative opioid use. Of these patients, 41 (1.1%) were in the 3G group and 106 (3.0%) were in the 2G group. In the 2G group, 53.8% patients ceased to have long-term postoperative use as compared with 27.8% in NG group. This association was significant on logistic regression analysis (OR 0.30, 95% CI: 0.20-0.46, P < 0.001). CONCLUSIONS:Chronic opioid users whose last opioid prescription was >2-months prior to spinal fusion and less than 14-days' supply had significantly lower risk of long-term postoperative opioid use. We have simulated "opioid weaning" in chronic opioid users undergoing major spinal fusion and our analysis provides an initial reference point for current clinical practice and future clinical studies.Level of Evidence: 3.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Jain N,Phillips FM,Malik AT,Khan SN

doi

10.1097/BRS.0000000000003744

subject

Has Abstract

pub_date

2021-01-15 00:00:00

pages

80-86

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-202101150-00005

journal_volume

pub_type

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Preoperative Opioid Weaning Before Major Spinal Fusion: Simulated Data, Real-World Insights.