Background context:
Best practices in opioid prescribing after elective surgery have been developed for most surgical subspecialties, including spine. However, some percentage of patients will become chronic users.
Purpose:
This study aimed to determine the relationship between the size of initial opioid prescription after surgery for degenerative spinal disease and the likelihood of refills.
Study design/setting:
Retrospective case-control study.
Patient sample:
Opioid-naïve patients aged 18-64 undergoing elective spinal procedures (anterior cervical discectomy and fusion, posterior cervical fusion, lumbar decompression and lumbar fusion) from 2010-2015 filling an initial perioperative prescription using insurance claims from Truven Health MarketScan (n=25,329).
Outcome measures:
Functional Measure: Healthcare utilization. Primary outcome was occurrence of an opioid refill within 30 postoperative days.
Methods:
We used logistic regression to examine the probability of an additional refill by initial opioid prescription strength, adjusting for patient factors.
Results:
26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery. The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories. Patient factors associated with increased likelihood of refills included age 30-39 years (OR 1.137, p=0.007, 95% CI 1.072-1.249), female gender (OR 1.137, p<0.001, 95% CI 1.072-1.207), anxiety disorder (OR 1.141, p=0.017, 95% CI 1.024-1.272), mood disorder (OR 1.109 p=0.049, 95% CI 1.000-1.229), and history of alcohol/substance abuse (OR 1.445 p=0.006, 95% CI 1.110-1.880).
Conclusions:
For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.
Keywords:
opioid; postoperative; spine surgery.