Predictors of long-term opioid dependence in transforaminal lumbar interbody fusion with a focus on pre-operative opioid usage

Aaron Hockley, David Ge, Dennis Vasquez-Montes, Mohamed A. Moawad, Peter Gust Passias, Thomas J. Errico, Aaron J. Buckland, Themistocles S. Protopsaltis, Charla R. Fischer

June 2020, Volume 29, Issue 6, pp 1311 - 1317 Original Article Read Full Article 10.1007/s00586-020-06345-3

First Online: 24 February 2020

Predictors of long-term opioid dependence in transforaminal lumbar interbody fusion with a focus on pre-operative opioid usage

Purpose

Predictors of long-term opioid usage in TLIF patients have not been previously explored in the literature. We examined the effect of pre-operative narcotic use in addition to other predictors of the pattern and duration of post-operative narcotic usage.

Methods

We conducted a retrospective cohort study at a single academic institution of patients undergoing a one- or two-level primary TLIF between 2014 and 2017. Total oral morphine milligram equivalents (MMEs) for inpatient use were calculated and used as the common unit of comparison.

Results

A multivariate binary logistic regression (R2 = 0.547, specificity 95%, sensitivity 58%) demonstrated that a psychiatric or chronic pain diagnosis (OR 3.95, p = 0.013, 95% CI 1.34–11.6), pre-operative opioid use (OR 8.65, p < 0.001, 95% CI 2.59–29.0), ASA class (OR 2.95, p = 0.025, 95% CI 1.14–7.63), and inpatient total MME (1.002, p < 0.001, 95% CI 1.001–1.003) were positive predictors of prolonged opioid use at 6-month follow-up, while inpatient muscle relaxant use (OR 0.327, p = 0.049, 95% CI 0.108–0.994) decreased the probability of prolonged opioid use. Patients in the pre-operative opioid use group had a significantly higher rate of opioid usage at 6 weeks (79% vs. 46%, p < 0.001), 3 months (51% vs. 14%, p < 0.001), and 6 months (40% vs. 5%, p < 0.001).

Conclusions

Pre-operative opioid usage is associated with higher total inpatient opioid use and a significantly higher risk of long-term opiate usage at 6 months. Approximately 40% of pre-operative narcotic users will continue to consume narcotics at 6-month follow-up, compared with 5% of narcotic-naïve patients.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[graphic not available: see fulltext]

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