P113. Preoperative opiate use leads to increased readmissions and opiate use following anterior cervical discectomy and fusion

Abstract

BACKGROUND CONTEXT Opiate use in the US has been recently recognized as a public health crisis. Opiate use and abuse carry presumptive negative health effects which require physicians, including spine surgeons, to be vigilant when treating patients. Multiple studies report detrimental effects of opiates on spine surgery outcomes such as lumbar fusion. However, further research is necessary to determine if similar effects are seen in anterior cervical discectomy and fusion surgery (ACDF). PURPOSE To determine the effects of preoperative opiate use on specific outcomes following ACDFs. STUDY DESIGN/SETTING Single center retrospective cohort study. PATIENT SAMPLE Adult patients from a single academic center who underwent elective 1 or 2 level ACDF from 2013 to 2018 were followed for 2 years after surgery. Exclusion criteria include fracture, instability, infection, neoplastic disease, fusion greater than 2 levels, fusion extending to occiput or thoracic spine, circumferential surgeries. Sample size was 198 patients. OUTCOME MEASURES Rates of reoperation up to 2 years post-surgery, emergency department (ED) visits up to 6 months post-surgery, inpatient readmission up to 1 year post-surgery, intraoperative blood loss, transfusions, and opiate use at 0-6 months and 6-12 months post-surgery converted to milligram morphine equivalents (MMEs). METHODS Patient records were reviewed from a single academic center from 2013 and 2018 for patients who met above study criteria. Patients were classified into three groups: opiate naive (ON: no history of opiate use), acute opiate use (AO: RESULTS There was no significant difference in ASA classification between ON, AO, CO (p value 0.917). Rates of reoperation were 3.9% for ON, 6.1% for AO, 6.7% for CO (p value 0.75). Rates of ED visits were 14.7% for ON, 9.1% AO, 20% for CO (p value 0.32). Rates of readmission were 11.8% for ON, 10.6% for AO and 40% for CO (p value 0.000351). Average operative times were 139.7 minutes for ON, 135.9 minutes for AO and 130.9 minutes CO (p value 0.668). Average length of stay was 2.1 days for ON, 1.7 days for AO, and 1.9 days for CO (p value 0.587). Average blood loss was 28.3 ml for ON, 29.2 ml for AO, and 71.8 ml for CO (p value 0.053). No patients required transfusions during surgery. Average opiate use measured in MME 0-6 months post-surgery was 92.67 for ON, 89.64 for AO, and 90.87 for CO (p value 0.957). Average opiate use measured in MME 6-12 months post-surgery was 5.76 for ON, 18.44 for AO, and 39.92 for CO (p value 0.00). Regarding smoking history, average rate of readmission was 8.5% for nonsmokers, 20.6% for former smokers, and 24.4% for active smokers (p value 0.0275). CONCLUSIONS There is statistically significant relationship between CO and higher readmission rates within 1 year after surgery. Preoperative opiate use is also associated with increased opiate use 6-12 months after surgery. Smoking history is also associated with increased rates of readmission. Relationship between opiate use and intraoperative blood loss approached but did not show statistical significance. There is no significant relationship between preoperative opiate use and rates of ED visits, reoperation, operative time, length of stay, or opiate consumption 0-6 months after surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.