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Association of Duration of Preoperative Opioid Use with Reoperation After One-Level Anterior Cervical Discectomy and Fusion in Non-Myelopathic Patients.

Abstract：

STUDY DESIGN:Retrospective Cohort Study OBJECTIVE.: To determine that rates of preoperative opioid use in patients undergoing single-level ACDF without myelopathy and determine the association with reoperations over 5 years SUMMARY OF BACKGROUND DATA.: Preoperative opioid use before cervical spine surgery has been linked to worse postoperative outcomes. However, no studies have determined the association of duration and type of opioid used with reoperations after anterior discectomy and fusion (ACDF). METHODS:Patients undergoing single-level ACDF without myelopathy between 2007 and 2016 with at least 5 year follow up were identified in one private insurance administrative database. Preoperative opiate use was divided into acute (within 3 months), subacute (acute use and use between 3-6 months), and chronic (subacute use and use prior to 6 months) and by the opiate medication prescribed (tramadol, oxycodone, and hydrocodone). Postoperative rates of additional cervical spine surgery were determined at 5-years and multivariate logistic regression was used to determine the association of preoperative opiates with additional surgery. RESULTS:Of 445 patients undergoing single-level ACDF without myelopathy, 66.3% were taking opioid medications prior to surgery. The most commonly used preoperative opioid was hydrocodone (50.3% acute use, 24.7% chronic use). Opioid naïve patients had a 5-year reoperation rate of 4.7%, compared to 25.0%, 15.5%, and 23.3% with chronic preoperative use of tramadol, hydrocodone, and oxycodone. In multivariate analysis, controlling for age, gender, and Charlson Comorbidity Index, chronic use of hydrocodone (odds ratio [OR] = 2.08, P = 0.05), oxycodone (OR = 4.46, P < 0.01), and tramadol (OR = 4.01, P = 0.01) were all associated with increased reoperations. However, acute use of hydrocodone, oxycodone, and tramadol were not associated with reoperations (P > 0.05). CONCLUSION:Both subacute and chronic use of common lower-dose opioid medications are associated with increased reoperations after single-level ACDF in non-myelopathic patients. This information is critical when counseling patients preoperatively and developing preoperative opioid cessation programs. LEVEL OF EVIDENCE:3.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Samuel AM,Lovecchio FC,Premkumar A,Vaishnav AS,Kim HJ,Qureshi SA

doi

10.1097/BRS.0000000000003861

subject

Has Abstract

pub_date

2020-12-07 00:00:00

eissn

0362-2436

issn

1528-1159

pub_type

杂志文章

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Association of Duration of Preoperative Opioid Use with Reoperation After One-Level Anterior Cervical Discectomy and Fusion in Non-Myelopathic Patients.