• Hannah A Levy, Brian A Karamian, Jose A Canseco, Jeffrey Henstenburg, Joseph Larwa, Brett Haislup, KayeI DavidIDDepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Barrett I Woods, Kris E Radcliff, Alan S Hilibrand, Christopher K Kepler, Alexander R Vaccaro, and Gregory D Schroeder.
• Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
• World Neurosurg. 2023 Mar 1; 171: e686e692e686-e692.

ObjectiveThe purpose of this study is to determine if increased postoperative prescription opioid dosing is an isolated predictor of chronic opioid use after anterior cervical diskectomy and fusion (ACDF).MethodsA retrospective cohort analysis of patients undergoing ACDF for degenerative diseases from 2016-2019 at a single institution was performed. Preoperative and postoperative opioid and benzodiazepine prescriptions, including morphine milligram equivalents (MMEs) and duration of use, were obtained from the Pennsylvania Prescription Drug Monitoring Program. Univariate analysis compared patient demographics and surgical factors across groups on the basis of postoperative opioid dose (high: MME ≥90, low: MME <90) and chronicity of use (chronic: ≥120 days or >10 prescriptions). Logistic regressions identified predictors of high opioid dose and chronic use.ResultsA total of 385 patients were included. Preoperative opioid tolerance and tobacco use were associated with high postoperative opioid dose and chronic usage. Younger age correlated with high-dose prescriptions. Increased body mass index and preoperative benzodiazepine use were associated with chronic opioid use. Chronic postoperative opioid use correlated with high-dose prescriptions, change in opioid prescribed, private pay scripts, and more than 1 prescriber and pharmacy. Logistic regression identified high postoperative opioid dose, opioid tolerance, increased body mass index, and no prior cervical surgery as predictors of chronic opioid use. Regression analysis determined younger age, increased medical comorbidities, and opioid tolerance to be predictors for high MME prescriptions.ConclusionsHigh postoperative opioid dose independently predicted chronic opioid use after ACDF regardless of preoperative opioid tolerance.Copyright © 2022 Elsevier Inc. All rights reserved.

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