Use of Higher-strength Opioids has a Dose-Dependent Association With Reoperations After Lumbar Decompression and Interbody Fusion Surgery

Abstract

Study design: A retrospective cohort study.

Objective: The aim of this study was to identify an association between preoperative opioid use and reoperations rates.

Summary of background data: Chronic opioid use is a public health crisis in the United States and has been linked to worse outcomes after lumbar spine surgery. However, no studies have identified an association between preoperative opioid use and reoperations rates.

Methods: A retrospective cohort study was conducted using patients from one private insurance database who underwent primary lumbar decompression/discectomy (LDD) or posterior/transforaminal lumbar interbody fusion (PLIF/TLIF). Preoperative use of five specific opioid medications (tramadol, hydromorphone, oxycodone, hydromorphone, and extended-release oxycodone) was categorized as acute (within 3 months), subacute (acute use and use between 3 and 6 months), or chronic (subacute use and use before 6 months). Multivariate regression, controlling for multilevel surgery, age, sex, and Charlson Comorbidity Index, was used to determine the association of each medication on reoperations within 5 years.

Results: A total of 11,551 patients undergoing LDD and 3291 patients undergoing PLIF/TLIF without previous lumbar spine surgery were identified. In the LDD group, opioid-naïve patients had a 5-year reoperation rate of 2.8%, compared with 25.0% and 8.0 with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of oxycodone was associated with increased reoperations (odds ratios [OR] = 1.4, 2.0, and 2.3, for acute, subacute, and chronic use; P < 0.01). Chronic use of hydromorphone was also associated with increased reoperations (OR = 7.5, P < 0.01).In the PLIF/TLIF group, opioid-naïve patients had a 5-year reoperation rate of 11.3%, compared with 66.7% and 16.8% with chronic preoperative use of hydromorphone and oxycodone, respectively. In multivariate analysis, any preoperative use of hydromorphone was associated with increased reoperations (OR = 2.9, 4.0, and 14.0, for acute, subacute, and chronic use; P < 0.05).

Conclusion: Preoperative use of the higher-potency opioid medications is associated with increased reoperations after LDD and PLIF/TLIF in a dose-dependent manner. Surgeons should use this data for preoperative opioid cessation counseling and individualized risk stratification.Level of Evidence: 3.

Figure 1.

(A) Preoperative hydromorphone use and reoperation rates after lumbar decompression/discectomy. (B) Preoperative oxycodone use and reoperation rates after lumbar decompression/discectomy. (C) Preoperative hydrocodone use and reoperation rates after lumbar decompression/discectomy. (D) Preoperative tramadol use and reoperation rates after lumbar decompression/discectomy. (E) Preoperative ER oxycodone use and reoperation rates after lumbar decompression/discectomy.

Figure 2.

(A) Preoperative hydromorphone use and reoperation rates after posterior lumbar interbody fusion. (B) Preoperative oxycodone use and reoperation rates after posterior lumbar interbody fusion. (C) Preoperative hydrocodone use and reoperation rates after posterior lumbar interbody fusion. (D) Preoperative tramadol use and reoperation rates after posterior lumbar interbody fusion. (E) Preoperative ER oxycodone use and reoperation rates after posterior lumbar interbody fusion.