What Are the Risk Factors for Continued Opioid Use in Patients Following Spinal Deformity Surgery Involving at Least Seven Operative Segments?

Introduction: Opioid prescriptions in the postoperative period have been implicated in the propagation of the current opioid epidemic. Although studies have explored acute opioid use within 30 days after surgery and chronic opioid use 90 days after surgery, opioid use in the subacute phase of 31-90 days after surgery has never been studied. This study aimed to identify factors common in opioid-naïve spinal deformity patients who are at a high risk of opioid use during the subacute phase of 31-90 days after discharge.

Methods: In this retrospective cohort study, we analyzed the electronic medical record of adult opioid-naïve spinal deformity patients who underwent >7 level spine surgeries at a quaternary medical care center from 2012 to 2019. Opioid refills in the subacute postoperative period of 31-90 days following discharge were assessed.

Results: Of 193 patients, 175 (90.7%) required inpatient opioids in the last 24 hours before discharge, 52 (26.9%) required an opioid prescription refill 1-30 days after discharge, and 60 (31.1%) required opioid prescription refill 31-90 days after discharge. An opioid prescription 1-30 days after discharge conferred the strongest risk of additional opioid prescriptions 31-90 days after discharge (OR 2.50, 95% CI 1.32-4.71, p=0.006). There was no difference in inpatient or discharge opioid dose requirements, length of discharge opioid prescription, case length, length of stay, or age between patients that did or did not obtain an opioid prescription 31-90 days after discharge.

Conclusion : In opioid-naïve spinal deformity patients, opioid prescription refills within 30 days after discharge was strongly associated with an increased risk of opioid prescription refills 31-90 days after discharge. This study enables physicians to identify patients at a higher risk of chronic opioid use and to intervene early during the postoperative course. Reducing opioid consumption within 30 days of hospital discharge after surgery may lead to lower long-term use.