• Lara Massie, Vidhya Gunaseelan, Jennifer Waljee, Chad Brummett, and Jason M Schwalb.
• Department of Neurosurgery, Duke University, 3480 Wake Forest Rd, Raleigh, NC 27609, USA.
• Spine J. 2021 May 1; 21 (5): 772-778.

Background ContextBest practices in opioid prescribing after elective surgery have been developed for most surgical subspecialties, including spine. However, some percentage of patients will become chronic users.PurposeThis study aimed to determine the relationship between the size of initial opioid prescription after surgery for degenerative spinal disease and the likelihood of refills.Study Design/SettingRetrospective case-control study.Patient SampleOpioid-naïve patients aged 18 to 64 undergoing elective spinal procedures (anterior cervical discectomy and fusion, posterior cervical fusion, lumbar decompression, and lumbar fusion) from 2010 to 2015 filling an initial perioperative prescription using insurance claims from Truven Health MarketScan (n=25,329).Outcome MeasuresFunctional measure: health-care utilization. Primary outcome was occurrence of an opioid refill within 30 postoperative days.MethodsWe used logistic regression to examine the probability of an additional refill by initial opioid prescription strength, adjusting for patient factors.ResultsAbout 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery. The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories. Patient factors associated with increased likelihood of refills included age 30 to 39 years (odds ratio [OR] 1.137, p=.007, 95% confidence interval [CI] 1.072-1.249), female gender (OR 1.137, p<.001, 95% CI 1.072-1.207), anxiety disorder (OR 1.141, p=.017, 95% CI 1.024-1.272), mood disorder (OR 1.109 p=.049, 95% CI 1.000-1.229), and history of alcohol/substance abuse (OR 1.445 p=.006, 95% CI 1.110-1.880).ConclusionsFor opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.Copyright © 2021 Elsevier Inc. All rights reserved.

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