Relationship Between Initial Opioid Prescription Size and Likelihood of Refill after Spine Surgery


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.

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