Spinal fusion surgery patients who took opioids for at least 3 months prior to surgery may be more likely to continue taking them 1 year afterward, according to a study published in Spine.
“We found over 40 percent of chronic preoperative users still were filling opioid prescriptions 12 months after surgery,” write Andrew J. Pugely and colleagues of University of Iowa Hospitals and Clinics, Iowa City, in a media release from Wolters Kluwer Health.
The study included approximately 26,500 patients undergoing lower spine fusion surgery (lumbar arthrodesis) between 2007 and 2015. Patients were identified from a nationwide insurance database; more than 90% were aged 50 years or older, and about 60% were women.
Overall, about 58% of patients had an active opioid prescription within 3 months before lumbar arthrodesis. Using 1-year follow-up data, the researchers compared opioid prescription filling rates for patients with preoperative opioid use (OU) versus “opioid-naive” (ON) patients who didn’t take opioids in the 3 months before surgery.
Throughout the year after spinal fusion, patients who had been taking opioids before surgery were more likely to continue to fill opioid prescriptions:
- At 1 month, about 83% of patients with preoperative opioid use had filled an opioid prescription, compared to 60% of opioid-naive patients.
- By 3 months, rates of prescription opioids declined, but remained higher in the OU group: 54%, compared to 14% in the ON group. After 6 months, rates of opioid prescriptions leveled off.
- At 1 year, about 42% of the OU group were still filling opioid prescriptions, compared to 9% of the ON group.
Preoperative opioid use was by far the strongest predictor of continued opioid use at 1 year. Risk was more than four times higher for patients in the OU group compared to the ON group. The magnitude of the risk increase varied for different types of spinal fusion surgery, the release explains.
Other risk factors included depression/anxiety, alcohol abuse, and drug dependence (besides opioids).
“In our experience, this prolonged opioid use after spine fusion surgery may be largely inappropriate,” Pugley and coauthors write.
They emphasize that they do not advocate eliminating the use of opioids for pain treatment after spinal surgery. However, they do recommend appropriate steps to prevent long-term opioid use after spinal fusion surgery, they conclude.
[Source(s): Wolters Kluwer Health, EurekAlert]