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Opioid Prescription Trends After Ambulatory Anterior Cervical Discectomy and Fusion

Published:November 22, 2022DOI:https://doi.org/10.1016/j.spinee.2022.11.010

      ABSTRACT

      Background Context

      Opioid utilization has been well studied for inpatient ACDF. However, the amount and type of opioids prescribed following ambulatory ACDF and the associated risk of persistent use are largely unknown.

      Purpose

      To characterize opioid prescription filling following single-level ambulatory anterior cervical discectomy and fusion (ACDF) compared to inpatient procedures.

      Study Design/Setting

      Retrospective cohort study.

      Patient Sample

      Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database.

      Outcome Measures

      Rate, amount, and type of perioperative opioid prescription.

      Methods

      Opioid-naive patients who underwent ambulatory (no overnight stay) or inpatient single-level ACDF from 2011 to 2019 were identified from a national insurance database. Perioperative opioids were defined as opioid prescriptions 30 days prior to and 14 days after the procedure. Rate, amount, and type of opioid prescription were characterized. Multivariable analyses controlling for any differences in demographics and comorbidities between the two treatment groups were utilized to determine any association between surgical setting and persistent opioid use (defined as the patient still filling new opioid prescriptions >90 days postoperatively).

      Results

      A total of 42,521 opioid-naive patients were identified, of which 2,850 were ambulatory and 39,671 were inpatient. Ambulatory ACDF was associated with slightly increased perioperative opioid prescription filling (52.7% versus 47.3% for inpatient procedures; p < 0.001). Among the 20,280 patients (47.7%) who filled perioperative opioid prescriptions, the average amount of opioids prescribed (in morphine milligram equivalents) was similar between ambulatory and inpatient procedures (550 versus 540, p=0.413). There was no association between surgical setting and persistent opioid use in patients who filled a perioperative opioid prescription, even after controlling for comorbidities, (adjusted odds ratio, 1.15, p=0.066).

      Conclusions

      Ambulatory ACDF patients who filled perioperative opioid prescriptions were prescribed a similar amount of opioids as those undergoing inpatient procedures. Further, ambulatory ACDF does not appear to be a risk factor for persistent opioid use. These findings are important for patient counseling as well as support the safety profile of this new surgical pathway.

      Key Words

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