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Preoperative opioids before adult spinal deformity surgery associated with increased reoperations and high rates of chronic postoperative opioid use at 3-year follow-up

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Abstract

Purpose

To determine the association of preoperative opioid prescriptions with reoperations and postoperative opioid prescriptions after adult spina deformity (ASD) surgery.

Summary of background data

With the current opioid crisis, patients undergoing surgery for ASD are at particular risk for opioid-related complications due to significant preoperative disability and surgical morbidity. No previous studies consider preoperative opioids in this population.

Methods

A retrospective cohort study of patients undergoing posterior spinal fusion (7 or more levels) for ASD was performed. All patients had at least 3 years of postoperative follow-up 3 years postoperatively. Prescriptions for 4 different opioid medications (hydromorphone, oxycodone, hydrocodone, and tramadol) were identified within 3 months preoperatively and up to 3 years postoperatively. Multivariate regression was utilized to determine the association of preoperative use with reoperations and with postoperative opioid use, controlling for both patient and surgery-related confounding factors.

Results

A total of 743 patients were identified and 59.6% (443) had opioid prescriptions within 3 months preoperatively. Postoperative opioid prescriptions were identified in 66.9% of patients at 12 months postoperatively, and in 54.8% at 36 months postoperatively. The 3-year reoperation rate was 11.0% in patients without preoperative prescriptions, 16.0% in patients with preoperative any opioid prescriptions (P = 0.07), and 34.8% in patients with preoperative hydromorphone prescriptions (P < 0.01). In multivariate analysis, preoperative opioid prescriptions were associated with increased reoperations (odds ratio [OR]: 1.62, P = 0.04), and chronic postoperative opioid use (OR: 4.40, P < 0.01). Preoperative hydromorphone prescriptions had the strongest association with both reoperations (OR: 4.96; P < 0.01) and chronic use (OR: 5.19: P = 0.03).

Conclusion

In the ASD population, preoperative opioids are associated with both reoperations and chronic opioid use, with hydromorphone having the strongest association. Further investigation of the benefits of preoperative weaning programs is warranted.

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Availability of data and material

Data are publicly available.

Code availability

PearlDiver BellWeather queries available upon request.

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Funding

No direct funding was received for this study. However, this study used REDCap (Research Electronic Data Capture) hosted at Weill Cornell Medicine Clinical and Translational Science Center supported by the National Center For Advancing Translational Science of the National Institute of Health under award number: UL1 TR002384. KWM was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number T32-AR078751. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Andre M. Samuel, Kyle W. Morse, Yuri A. Pompeu, Avani S. Vaishnav, Catherine Himo Gang, Han Jo Kim & Sheeraz A. Qureshi

  2. Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA

    Han Jo Kim & Sheeraz A. Qureshi

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  1. Andre M. Samuel
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AMS, KM, and YP. The first draft of the manuscript was written by AMS, KWM, and YP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sheeraz A. Qureshi.

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Conflict of interest

The authors of this manuscript have no conflicts of interest related to the topic of this study. AMS, KM, YP, ASV, CHG: No relevant financial or non-financial interests to disclose. HJK: Financial interests: Royalties: Zimmer Biomet, K2M; Private investments: HS2, Spine Stud; Consulting: Zimmer Biomet Holdings, K2M; Research Support: ISSG; Travel: Zimmer Biomet Holdings, Nuvasive, Inc. Innovasis, Inc. Non-financial interests: Board or committee member: AAOS, AO Spine, Cervical Spine Research Society, Scoliosis Research Society; SAQ: Financial interests: Consulting: Globus Medical, Inc., Paradigm Spine (Past relationship), Stryker K2M; Other: Simplify Medical, Inc. (Clinical Events Committee Member); Private Investments: Tissue Differentiation Intelligence, Vital 5 (Past relationship); Royalties: Globus Medical, Inc., Stryker K2M; Scientific Advisory Board: Healthgrades (Past relationship), Lifelink.Com Inc., Spinal Simplicity, LLC; Speaking and/or Teaching Arrangements: Amopportunities (Honoraria), Globus Medical, Inc. (Speakers' Bureau), RTI Surgical Inc.; Trips/Travel: Globus Medical, Inc., Integrity Implants Inc, Medical Device Business Services, Medtronic USA, Inc., Nuvasive, Inc., Paradigm Spine, Stryker K2M. Non-financial interests: Board of Directors: Society Of Minimally Invasive Spine Surgery; Editorial Board Member: Annals Of Translational Medicine, Contemporary Spine Surgery; Committee Member: Association Of Bone And Joint Surgeons, Cervical Spine Research Society, International Society For The Advancement Of Spine Surgery, Lumbar Spine Research Society, North American Spine Society, Society Of Minimally Invasive Spine Surgery; Board Member: Minimally Invasive Spine Study Group, Society Of Minimally Invasive Spine Surgery.

Ethical approval

This study was performed under an Approved Exemption by the Hospital for Special Surgery Institutional Review Board (protocol number 2020-0327).

Consent to participate

All patients signed freely given, informed consent to participate, prior to inclusion in this clinical data registry. All data were then de-identified prior to use by the study authors.

Consent for publication

All patients signed freely given, informed consent for publication, prior to inclusion in this clinical data registry. All data were then de-identified prior to use by the study authors.

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Samuel, A.M., Morse, K.W., Pompeu, Y.A. et al. Preoperative opioids before adult spinal deformity surgery associated with increased reoperations and high rates of chronic postoperative opioid use at 3-year follow-up. Spine Deform 10, 615–623 (2022). https://doi.org/10.1007/s43390-021-00450-z

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