Jain N, et al. - In a large cohort of patients who underwent primary cervical fusion for degenerative pathology experts investigated whether the patient profile was associated with pre-operative COT; pre-operative COT was a risk factor for 90-day systemic complications, Emergency Department (ED) visits, readmission, and 1-year adverse events. In addition they assessed the risk factors and 1-year adverse events related to the long-term post-operative opioid use and how much payers reimbursed for management of complications and adverse events. Complication rate, postoperative opioid usage, healthcare resource utilization and costs were increased with pre-operative opioid use among cervical fusion patients. By restricting the duration of pre-operative opioid use or weaning off before surgery, these risks could be reduced. In the pre-operative period, better understanding and management of pain with judicious use of opioids was critical to enhanced outcomes after cervical fusion surgery.

Methods

• Authors conducted a retrospective review of Humana commercial insurance data (2007-Q3 2015) in 29,101 patients undergoing primary cervical fusion for degenerative pathology.
• They included the patients and procedures of interest using International Classification of Diseases (ICD) coding.
• They considered the patients with opioid prescriptions for >6 months before surgery as having pre-operative COT.
• They considered the patients with continued opioid use till one-year after surgery as long-term users.
• Researchers conducted a descriptive analysis of patient cohorts.
• To answer first 3 study questions, multiple-variable logistic regression analyses adjusting for approach, number of levels of surgery, discharge disposition, and comorbidities were done.
• To answer the fourth study question, reimbursement data from insurers has been reported.

Results

• As per findings, out of the entire cohort, 6,643 (22.8%) had pre-operative COT.
• Findings suggested that pre-operative COT was related to a higher risk of 90-day wound complications (OR 1.39, 95% CI:1.16-1.66), all-cause 90-day ED visits (adjusted OR 1.22, 95% CI:1.13-1.32), and pain-related ED visits (adjusted OR 1.39, 95% CI:1.24-1.55).
• Data demonstrated greater likeliness of the patients who had pre-operative COT to receive epidural and/or facet joint injections within 1-year after surgery (adjusted OR 1.68, 95% CI: 1.47-1.92).
• Compared to patients who did not have pre-operative COT, these patients were also more likely to undergo a repeat cervical fusion within a year (adjusted OR 1.21, 95% CI: 1.01-1.43).
• A higher likelihood of long-term use after surgery of pre-operative COT was seen (adjusted OR 4.72, 95% CI:4.41-5.06).
• Researchers noted an association of long-term opioid use after surgery with a higher risk of new-onset constipation (adjusted OR 1.34, 95% CI:1.22-1.48).
• They did not found the risk of complications and adverse events to be significant in patients with < 3-months pre-operative opioid use or those who stopped opioids for at-least 6-weeks before surgery.
• Results showed that the cost of additional resource use for medications, ED visits, constipation, injections and revision fusion ranged from $623-$27,360 per patient.