Predictive Risk Factors Associated With Increased Opioid Use Among Patients Undergoing Elective Spine Surgery

Background Opioids are commonly used for postoperative pain management in spine surgery. However, few guidelines exist for appropriate prescribing in the acute postoperative phase of care. We identify risk factors for inpatient (IP) opioid use and examine relationships between IP requirements and discharge (DC) opioid prescriptions.

Methods Retrospective review of elective spine surgeries between January 2014 and May 2018 identified cases of lumbar decompression (LD), LD with fusion (LDF), and cervical decompression with fusion (CDF) at our high-volume spine center. Multiple regression examining potential risk factors for opioid use was performed. Opioid use was normalized into daily morphine milligram equivalents (MME).

Results A total of 2281 patients who underwent 1251 LD, 384 LDF, and 648 CDF procedures were identified (54.1% male, mean age = 57.9 years, mean body mass index = 30.3 kg/m², median American Society of Anesthesiologists [ASA] score = 2). Mean IP opioid use was 44.4 MME/day and average DC prescriptions totaled 496.5 MME. Multiple regression models identified younger age and increased ASA score as predictive of increased daily IP opioid consumption (β_AGE = −0.36, P < .001, β_ASA = 10.1, P < .001; R² = 0.308) and increased DC opioid amounts (β_AGE = −4.62, P < .001, β_ASA = 72.1, P < .001; R² = 0.097). Highest IP and DC opioid use was observed among LDF followed by CDF and LD patients. Significant positive correlations were found between IP opioid usage and DC opioid prescriptions by IP opioid quartiles (r = 0.99 LD, 0.98 LDF, 0.96 CDF).

Conclusions Younger patients and higher ASA scores correlated with increased IP opioid use and DC opioid prescriptions. DC prescriptions appropriately reflect IP use.

Level of Evidence 3.

Clinical Relevance Adequate pain management is an integral component to successful outcomes in spine surgery. Awareness of candidates likely to require higher levels of opioid analgesia will be beneficial in guiding surgeon prescribing practices.