Use of Prescription Opioids Before and After Lumbar Fusion Surgery

• Adults undergoing lumbar fusion surgery (N = 2491) for chronic back pain were retrospectively followed to evaluate patterns of opioid use following surgery. Long-term opioids were used by 1045 individuals before surgery and by 1094 individuals postoperatively. Long-term postoperative use of opioids was observed in 77.1% of preoperative users and an episodic use was noted in a further 13.8% as compared with 12.8% in individuals with no preoperative use. Only 9.1% of preoperative users discontinued using opioids following surgery. The cumulative preoperative opioid dose was the strongest predictor of long-term use after surgery.
• Individuals undergoing lumbar fusion surgery for chronic back pain may not be able to eliminate the need for opioids postsurgery, and, in fact, non-users may be at a significant risk of initiating long-term use following surgery.

Abstract

Lumbar fusion surgery is usually prompted by chronic back pain, and many patients receive long-term preoperative opioid analgesics. Many expect surgery to eliminate the need for opioids. We sought to determine what fraction of long-term preoperative opioid users discontinue or reduce dosage postoperatively; what fraction of patients with little preoperative use initiate long-term use; and what predicts long-term postoperative use. This retrospective cohort study included 2,491 adults undergoing lumbar fusion surgery for degenerative conditions, using Oregon’s prescription drug monitoring program to quantify opioid use before and after hospitalization. We defined long-term postoperative use as ≥ 4 prescriptions filled in the 7 months following hospitalization, with at least 3 occurring > 30 days after hospitalization. Overall, 1,045 patients received long-term opioids preoperatively, and 1,094 postoperatively. Among long-term preoperative users, 77.1% continued long-term postoperative use, and 13.8% had episodic use. Only 9.1% discontinued or had short-term postoperative use. Among preoperative users, 34.4% received a lower dose postoperatively, but 44.8% received a higher long-term dose. Among patients with no preoperative opioids, 12.8% became long-term users. In multivariable models, the strongest predictor of long-term postoperative use was cumulative preoperative opioid dose (odds ratio of 15.47 (95% CI 8.53, 28.06) in the highest quartile). Cumulative dose and number of opioid prescribers in the 30-day postoperative period were also associated with long-term use. Thus, lumbar fusion surgery infrequently eliminated long-term opioid use. Opioid-naïve patients had a substantial risk of initiating long-term use. Patients should have realistic expectations regarding opioid use following lumbar fusion surgery.