• David J Cook, Samuel Kaskovich, Sean Pirkle, Alisha Ho, Megan Conti Mica, Lewis Shi, and Michael Lee.
• Pritzker School of Medicine, University of Chicago, Chicago, IL.
• Spine. 2019 Dec 1; 44 (23): 1668-1675.

Study DesignA retrospective cohort study performed in a nationwide insurance claims database.ObjectiveThis study aimed to examine duration and magnitude of postoperative opioid prescriptions following common spinal procedures.Summary Of Background DataPostoperative opioid prescription practices vary widely among providers and procedures and standards of care are not well-established. Previous work does not adequately quantify both duration and magnitude of opioid prescription.MethodsForty seven thousand eight hundred twenty three patients with record of any of four common spinal procedures in a nationwide insurance claims database were stratified by preoperative opioid use into three categories: "opioid naive," "sporadic user," or "chronic user," defined as 0, 1, or 2+ prescriptions filled in the 6 months preceding surgery. Those with record of subsequent surgery or readmission were excluded. Duration of opioid use was defined as the time between the index surgery and the last record of filling an opioid prescription. Magnitude of opioid use was defined as milligram morphine equivalents (MME) filled by 30 days post-op, converted to 5 mg oxycodone pills for interpretation.ResultsOpioid naive patients were less likely than chronic opioid users to fill any opioid prescription after surgery (63-68% naive vs. 91-95% chronic, P < 0.001), and when they did, their prescriptions were smaller in magnitude (76-91 pills naive vs. 127-152 pills chronic). One year after surgery, 15% to 18% of opioid naive and 50% to 64% of chronic opioid users continued filling prescriptions.ConclusionOpioid naive patients use less postoperative opioids, and for a shorter period of time, than chronic users. This study serves as a normative benchmark for examining postoperative opioid use, which can assist providers in identifying patients with opioid dependence. Importantly, this work calls out the high risk of opioid exposure, as 15% to 18% of opioid naive patients continued filling opioid prescriptions 1 year after surgery.Level Of Evidence3.

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