Patients who have been taking opioid pain relievers for several months before spinal fusion surgery are at increased risk of complications after their surgery, according to a study published in Spine.
“With increasing emphasis on cost containment and quality improvement, our findings are intended to caution providers about chronic opioid therapy as a risk factor for additional interventions and costs after lumbar fusion,” wrote Safdar N. Khan, MD, Ohio State University Wexner Medical Center, Columbus, Ohio, and colleagues.
Using an insurance database, the researchers identified 24,610 patients undergoing spinal fusion in the lumbar spine. Of these, 5,500 patients (22.3%) were taking opioid pain relievers for more than 6 months before their surgery. Several factors were linked to an increased rate of chronic opioid therapy: tobacco use disorder, drug abuse/dependence, anxiety, depression, and inflammatory arthritis.
A wide range of complications were more frequent for patients taking long-term opioids. In the first 90 days after spinal fusion, the odds of surgical wound complications were 19% higher for chronic opioid users, relative to those with no or less than 6 months of opioid use.
Chronic opioid therapy was also associated with a higher likelihood of emergency department visits and hospitalisations within 90 days. The odds were especially high for issues related to lumbar spine pain — a 31% relative increase in emergency visits and an 80% increase in hospital admissions.
Patients taking chronic opioids before surgery were 8 times more likely to still be taking opioids 1 year afterward. They had a 33% relative increase in the likelihood of repeat spinal fusion surgery within 1 year.
“All these findings highlight the vicious cycle of unrelieved pain and fusion and increased healthcare costs in long-term opioid users,” the authors wrote.
Spine surgeons should be vigilant about the increased complications and higher costs in patients receiving chronic opioid therapy before spinal fusion surgery.
“As we head toward a value- and outcomes-based reimbursement system, spine surgeons need to incorporate preoperative opioid use into their surgical decision making,” the authors concluded.