Assessment of Surgical Complications Strengthen the Relationship Between Spine Surgery Procedure Intensity and Chronic Opioid use After Surgery

Study Design. Prospective cohort using routinely-collected health data Objective. To compare opioid use based on surgery intensity (low or high). Summary of Background Data. Many factors influence an individual’s experience of pain. The extent to which post-surgical opioid use is influenced by the severity of spine surgery is unknown. Methods. The participants were individuals undergoing spine surgery in a large military hospital. Procedures were categorized as low-intensity (e.g., microdiscectomy and laminectomy) and high-intensity (e.g., fusion and arthroplasty). The Surgical Scheduling System and Military Health System Data Repository were queried for healthcare utilization the 1 year before and after surgery. We compared opioid use after surgery between groups, adjusting for prior opioid use and surgical complications. Results. 342 individuals met the inclusion criteria, mean age 45.4 years (SD 10.9), 33.0% female. Of these, 221(64.6%) underwent a low-intensity procedure and 121(35.4%) underwent a high-intensity procedure. Mean postoperative opioid prescription fills were greater in the high- versus low-intensity group (9.0 vs. 5.7; P <0.001), as were the mean total days’ supply (158.9 vs. 81.8; P <0.001). Median morphine milligram equivalents were not significantly different (MME; 40.2 vs. 42.7; P =0.287). 26.3% of the cohort were chronic opioid users after surgery. Adjusted rates of long-term opioid use were not different between groups when only accounting for prior opioid use, but significantly higher for the high-intensity group when adjusting for surgical complications (OR=2.08;95CI 1.09,3.97). 52.5% of the entire cohort was still filling opioid prescriptions after six months. Conclusion. Higher-intensity procedures were associated with greater postoperative opioid use than lower-intensity procedures. Chronic opioid use was not significantly different between surgical intensity groups when considering only prior opioid use. Chronic opioid use was significantly higher among higher intensity procedures when accounting for surgical complications. The prresence of surgical complications is a stronger predictor of post-surgical long-term opioid use in high intensity surgeries than history of opioid use alone.