TY - JOUR
T1 - Opioid Utilization in Geriatric Patients after Operation for Degenerative Spine Disease
AU - Nguyen, Anthony V.
AU - Ross, Evan
AU - Westra, Jordan
AU - Huang, Nicole
AU - Nguyen, Christine Y.
AU - Raji, Mukaila
AU - Lall, Rishi
AU - Kuo, Yong Fang
N1 - Funding Information:
Received for publication September 15, 2019; accepted January 17, 2020. From the *School of Medicine; †Department of Surgery; ‡Preventive Medicine and Community Health, Office of Biostatistics; §Depart-ment of Internal Medicine, Division of Geriatrics; and ∥Department of Surgery, Division of Neurosurgery, The University of Texas Medical Branch, Galveston, TX. This study was funded by the National Institutes of Health (grants R01DA039192 and 2T32GM008256. Parts of this work were presented at the 22nd Annual Forum on Aging (October 2018, Galveston, TX), American Association of Neuro-logical Surgeons 2019 Annual Scientific Meeting (April 2019, San Diego, CA), 60th Annual National Student Research Forum (April 2019, Galveston, TX), and the American Geriatrics Society 2019 Annual Scientific Meeting (May 2019, Portland, OR). The authors have no conflicts of interest to disclose. Address correspondence to: Anthony V. Nguyen, BA. E-mail: antvnguy@ utmb.edu. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.jnsa.com. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/ANA.0000000000000682
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Few studies have investigated opioid utilization by geriatric patients after spinal surgery, a population in whom degenerative spine disease (DSD) is highly prevalent. We aimed to quantify rates of chronic, continuous opioid utilization by geriatric patients following spine surgery for DSD-related diagnoses. Materials and Methods: Utilizing a national 5% Medicare sample database, we investigated individuals aged above 66 years who underwent spinal surgery for a DSD-related diagnosis between the years of 2008 and 2014. The outcomes of interest were the rate of and risk factors for continuous opioid utilization at 1-year following anterior cervical discectomy and fusion, posterior cervical fusion, 360-degree cervical fusion, lumbar microdiscectomy, lumbar laminectomy, posterior lumbar fusion, anterior lumbar fusion, or 360-degree lumbar fusion for a DSD-related diagnosis. Results: Of the 14,583 Medicare enrollees who met study criteria, 6.0% continuously utilized opioids 1-year after spinal surgery. When stratified by preoperative opioid utilization (with the prior year divided into 4 quarters), the rates of continuous utilization at 1-year postsurgery were 0.3% of opioid-naive patients and 23.6% of patients with opioid use in all 4 quarters before surgery. Anxiety, benzodiazepine use within the year before surgery, and Medicaid dual-eligibility were associated with prolonged opioid utilization. Conclusions: Of opioid-naive geriatric patients who underwent surgery for DSD, 0.3% developed chronic, continuous opioid use. Preoperative opioid use was the strongest predictor of prolonged utilization, which may represent suboptimal use of nonopioid alternatives, pre-existing opioid use disorders, delayed referral for surgical evaluation, or over-prescription of opioids for noncancer pain.
AB - Background: Few studies have investigated opioid utilization by geriatric patients after spinal surgery, a population in whom degenerative spine disease (DSD) is highly prevalent. We aimed to quantify rates of chronic, continuous opioid utilization by geriatric patients following spine surgery for DSD-related diagnoses. Materials and Methods: Utilizing a national 5% Medicare sample database, we investigated individuals aged above 66 years who underwent spinal surgery for a DSD-related diagnosis between the years of 2008 and 2014. The outcomes of interest were the rate of and risk factors for continuous opioid utilization at 1-year following anterior cervical discectomy and fusion, posterior cervical fusion, 360-degree cervical fusion, lumbar microdiscectomy, lumbar laminectomy, posterior lumbar fusion, anterior lumbar fusion, or 360-degree lumbar fusion for a DSD-related diagnosis. Results: Of the 14,583 Medicare enrollees who met study criteria, 6.0% continuously utilized opioids 1-year after spinal surgery. When stratified by preoperative opioid utilization (with the prior year divided into 4 quarters), the rates of continuous utilization at 1-year postsurgery were 0.3% of opioid-naive patients and 23.6% of patients with opioid use in all 4 quarters before surgery. Anxiety, benzodiazepine use within the year before surgery, and Medicaid dual-eligibility were associated with prolonged opioid utilization. Conclusions: Of opioid-naive geriatric patients who underwent surgery for DSD, 0.3% developed chronic, continuous opioid use. Preoperative opioid use was the strongest predictor of prolonged utilization, which may represent suboptimal use of nonopioid alternatives, pre-existing opioid use disorders, delayed referral for surgical evaluation, or over-prescription of opioids for noncancer pain.
KW - analgesics
KW - epidemiology
KW - geriatrics
KW - neurosurgery
KW - opioids
KW - osteoarthritis
KW - spine
UR - http://www.scopus.com/inward/record.url?scp=85080074269&partnerID=8YFLogxK
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U2 - 10.1097/ANA.0000000000000682
DO - 10.1097/ANA.0000000000000682
M3 - Article
C2 - 32091468
AN - SCOPUS:85080074269
VL - 33
SP - 315
EP - 322
JO - Journal of Neurosurgical Anesthesiology
JF - Journal of Neurosurgical Anesthesiology
SN - 0898-4921
IS - 4
ER -