Prolonged Opioid Use following Cervical Spine Fusion Surgeries-Incidence and Predictors of Use

Purpose: To determine the incidence and predictors of prolonged opioid use (OU) following cervical spine fusion surgery. Methods: This is a retrospective cohort study of all patients who underwent cervical arthrodesis for degenerative cervical spine disease over 7 years, between 2010 and 2016, who had at least one year of postoperative follow up at the University of Missouri hospitals. Review of medical records was done to collect data on patient's characteristics, associated pain measures (pre/postoperative VAS), ASA score, and pre/postoperative OU. The predictors of prolonged OU at 3, 6 and 12 months following surgery were identified using the logistic regression analyses. Significance was considered at p<0.05. Results: Incidences of postoperative OU were 50%, 42.5% and 30.2% at 3, 6 and 12 months respectively. After adjustment for all possible confounders, preoperative OU was a significant predictor of postoperative OU at 3 months (OR=3.06, 95% CI: 1.28-7.34, p=0.012), 6 months (OR=2.86, 95% CI: 1.01-8.14, p=0.049) and 12 months (OR=7.22, 95% CI: 2.76-18.90, p<0.001). Patients with cancer diagnosis were 23 times more likely to be prolonged opioid users for 12 months after surgery (OR= 23.13, 95% CI: 1.68-317.98, p=0.019). Conclusion: Perioperative opioid prescription for patients with cervical spine fusion is quite common. Further prospective study is necessary to minimize the effect of confounding variables such as; disease severity, and postoperative functional status on the associations between pre-and postoperative opioid use. Minimizing preoperative opioid use should be investigated as a way to mitigate long–term opioid use.