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

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 (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 ...
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research