Chronic Opioid Use Following Lumbar Discectomy: Prevalence, Risk Factors, and Current Trends in the United States

Abstract

Objective: Lumbar discectomy is commonly performed for symptomatic lumbar disc herniation. We aimed to examine prescribing patterns and risk factors for chronic opioid use following lumbar discectomy.

Methods: Using a private insurance claims database, patients were identified who underwent primary lumbar discectomy from 2010-2015 and had 1-year of continuous enrollment postoperatively. Patients were excluded with spinal fusion. The strength of opioid prescriptions was quantified using morphine milligram equivalents daily (MMED). Univariate and multivariate logistic regression models were built to examine risk factors associated with chronic postoperative opioid use.

Results: A total of 5,315 patients were included in the study (mean age, 59 years; 50% female). 1,198 of patients (23%) used chronic opioids postoperatively. Chronic opioid use declined significantly from 27% in 2010 to 17% in 2015, p < 0.001. In addition, there were significantly fewer patients receiving high and very high-dose opioid prescriptions from 2010-2015, p < 0.001. The median duration that patients used opioids postoperatively was 211 days in 2010 (interquartile range [IQR], 29-356 days), and decreased significantly to 44 days (IQR, 10-294 days) in 2015. The strongest factors associated with chronic opioid use were preoperative opioid use (odds ratio [OR], 4.0), drug abuse (OR, 2.6), depression (OR, 1.6), surgery in the west (OR, 1.6) or south (OR, 1.6), anxiety (OR, 1.5), or 30-day readmission (OR, 1.4).

Conclusion: Chronic opioid use following primary lumbar discectomy has declined from 2010-2015. A variety of factors are associated with chronic opioid use. Preoperative recognition of some of these risk factors may aid in perioperative management and counseling.

Keywords: Diskectomy; Lumbar vertebrae; Opioid analgesics; Prevalence; Risk factor.

Fig. 1.

Cohort selection flowchart.

Fig. 2.

Proportion of patients receiving high-dose (≥90 MMED) and very high-dose (≥ 200 MMED) opioid prescriptions in the preoperative, perioperative, and postoperative period surrounding lumbar discectomy. In the preoperative period, 3,105 of patients (58%) received at least one opioid prescription, with 636 of these patients (20%) receiving at least one high-dose opioid prescription (≥ 90 MMED) and 139 of patients (4.5%) receiving at least one very high-dose opioid prescription (≥ 200 MMED). In the perioperative period, 5,111 of patients (96%) received at least one opioid prescription, with 2,217 of these patients (43%) receiving at least one high-dose opioid prescription (≥ 90 MMED) and 302 of patients (5.9%) receiving at least one very high-dose opioid prescription (≥ 200 MMED). In the postoperative period, 2,146 of patients (40%) received at least one opioid prescription, with 461 of these patients (21%) receiving at least one high-dose opioid prescription (≥ 90 MMED) and 129 of patients (6.0%) receiving at least one very high-dose opioid prescription (≥ 200 MMED). MMED, morphine milligram equivalents daily.