1081 Risk Factors for Long Term Opioid Use After Elective Lumbar Spine Surgery: A MSSIC Study

INTRODUCTION: Long-term opioid use after elective lumbar spine surgery is a significant concern, given the current opioid epidemic and its impact on public health. Identifying risk factors for long-term opioid use after spine surgery is crucial in developing effective interventions to reduce the incidence of opioid dependence in this patient population. METHODS: A retrospective analysis of patient data was conducted using the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Patients who underwent elective lumbar spine surgery between March 2018, and September 2021, were included, resulting in a total of 3599 patients at one year and 966 patients at two years follow-up. Poisson generalized estimating equation models were used for multivariate analyses. RESULTS: A total of 493 (13.7%) and 137 (14.2%) patients were still using opiates at one-year and two-years post-surgery respectively. Discharge morphine milligram equivalents (MMEs), baseline PROMIS PF functional scores, baseline pain scores, age, gender, education level, pre-operative opioid use, and not achieving the minimal clinically important difference (MCID) in PROMIS PF scores at follow-up were significantly associated with long-term opioid use. Specifically, pre-operative opioid use had the strongest association with opioid use at one year (IRR = 2.83, CI: 2.40-3.34, p < 0.001) and two years (IRR = 3.79, CI: 2.53-5.68, p < 0.001). Additionally, not achieving MCID in PROMIS scores at follow-up was strongly associated (IRR = 2.00, CI: 1.72-2.32, p < 0.001 and IRR = 2.18, CI: 1.64-2.91, p < 0.001) with opioid use at both time points (1-year and 2-year respectively). CONCLUSIONS: Pre-operative opioid use and not achieving MCID in PROMIS scores at follow-up were the strongest predictors of long-term opioid use after elective lumbar spine surgery. Identifying these risk factors can help clinicians target interventions to reduce opioid use in at-risk patients and improve postoperative outcomes.