Predictors of Long Term Opioid Use following Lumbar Fusion Surgery

Joseph Connolly, Zulqarnain Javed, Mukaila Raji, Winston Chan, Yong Fang Kuo, Jacques Baillargeon

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

STUDY DESIGN.: A population-based retrospective cohort study. OBJECTIVE.: The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA.: Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS.: Using one of the nationʼs largest commercial insurance databases, we conducted a retrospective cohort study of 8,377 adults, aged 21- 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009 and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long term opioid use following lumbar fusion. RESULTS.: After adjusting for covariates, the following factors were associated with an increased risk of long term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR?=?2.27, 95% CI?=?1.48–3.49; Quartile 2(23–72 days): OR?=?5.94, 95% CI?=?4.00–8.83; Quartile 3: (73–250 days) OR?=?25.31, 95% CI?=?17.26–37.10; Quartile 4 (≥ 250days) OR?=?219.95, 95% CI?=?148.53–325.71)], re-fusion surgery (OR?=?1.32, 95% CI?=?1.02–1.72), and diagnosis of depression (OR?=?1.43, 95% CI?=?1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR?=?0.79, 95% CI?=?0.63–0.99). CONCLUSIONS.: These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Mar 3 2017

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Opioid Analgesics
Odds Ratio
Spinal Fusion
Prescriptions
Cohort Studies
Retrospective Studies
Pain Management
Low Back Pain
Insurance
Logistic Models
Databases
Confidence Intervals
Depression
Physicians

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Predictors of Long Term Opioid Use following Lumbar Fusion Surgery. / Connolly, Joseph; Javed, Zulqarnain; Raji, Mukaila; Chan, Winston; Kuo, Yong Fang; Baillargeon, Jacques.

In: Spine, 03.03.2017.

Research output: Contribution to journalArticle

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title = "Predictors of Long Term Opioid Use following Lumbar Fusion Surgery",
abstract = "STUDY DESIGN.: A population-based retrospective cohort study. OBJECTIVE.: The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA.: Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS.: Using one of the nationʼs largest commercial insurance databases, we conducted a retrospective cohort study of 8,377 adults, aged 21- 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009 and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95{\%} confidence intervals for the risk of long term opioid use following lumbar fusion. RESULTS.: After adjusting for covariates, the following factors were associated with an increased risk of long term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR?=?2.27, 95{\%} CI?=?1.48–3.49; Quartile 2(23–72 days): OR?=?5.94, 95{\%} CI?=?4.00–8.83; Quartile 3: (73–250 days) OR?=?25.31, 95{\%} CI?=?17.26–37.10; Quartile 4 (≥ 250days) OR?=?219.95, 95{\%} CI?=?148.53–325.71)], re-fusion surgery (OR?=?1.32, 95{\%} CI?=?1.02–1.72), and diagnosis of depression (OR?=?1.43, 95{\%} CI?=?1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR?=?0.79, 95{\%} CI?=?0.63–0.99). CONCLUSIONS.: These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.Level of Evidence: 3",
author = "Joseph Connolly and Zulqarnain Javed and Mukaila Raji and Winston Chan and Kuo, {Yong Fang} and Jacques Baillargeon",
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T1 - Predictors of Long Term Opioid Use following Lumbar Fusion Surgery

AU - Connolly, Joseph

AU - Javed, Zulqarnain

AU - Raji, Mukaila

AU - Chan, Winston

AU - Kuo, Yong Fang

AU - Baillargeon, Jacques

PY - 2017/3/3

Y1 - 2017/3/3

N2 - STUDY DESIGN.: A population-based retrospective cohort study. OBJECTIVE.: The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA.: Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS.: Using one of the nationʼs largest commercial insurance databases, we conducted a retrospective cohort study of 8,377 adults, aged 21- 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009 and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long term opioid use following lumbar fusion. RESULTS.: After adjusting for covariates, the following factors were associated with an increased risk of long term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR?=?2.27, 95% CI?=?1.48–3.49; Quartile 2(23–72 days): OR?=?5.94, 95% CI?=?4.00–8.83; Quartile 3: (73–250 days) OR?=?25.31, 95% CI?=?17.26–37.10; Quartile 4 (≥ 250days) OR?=?219.95, 95% CI?=?148.53–325.71)], re-fusion surgery (OR?=?1.32, 95% CI?=?1.02–1.72), and diagnosis of depression (OR?=?1.43, 95% CI?=?1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR?=?0.79, 95% CI?=?0.63–0.99). CONCLUSIONS.: These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.Level of Evidence: 3

AB - STUDY DESIGN.: A population-based retrospective cohort study. OBJECTIVE.: The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. SUMMARY OF BACKGROUND DATA.: Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. METHODS.: Using one of the nationʼs largest commercial insurance databases, we conducted a retrospective cohort study of 8,377 adults, aged 21- 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009 and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long term opioid use following lumbar fusion. RESULTS.: After adjusting for covariates, the following factors were associated with an increased risk of long term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR?=?2.27, 95% CI?=?1.48–3.49; Quartile 2(23–72 days): OR?=?5.94, 95% CI?=?4.00–8.83; Quartile 3: (73–250 days) OR?=?25.31, 95% CI?=?17.26–37.10; Quartile 4 (≥ 250days) OR?=?219.95, 95% CI?=?148.53–325.71)], re-fusion surgery (OR?=?1.32, 95% CI?=?1.02–1.72), and diagnosis of depression (OR?=?1.43, 95% CI?=?1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR?=?0.79, 95% CI?=?0.63–0.99). CONCLUSIONS.: These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.Level of Evidence: 3

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