Abstract
Background Anterior cervical diskectomy and fusion (ACDF) is a procedure for effectively relieving
radiculopathy. Opioids are commonly overprescribed in postsurgical settings and prescriptions
vary widely among providers. We identify trends in opioid dependence before and after
ACDF.
Methods We used the Truven Health MarketScan data to identify adult patients undergoing ACDF
for degenerative cervical spine conditions between 2009 and 2015. Patients were segregated
in four cohorts of preoperative and postoperative opioid nondependence (ND) or dependence
(D) with 15 months of postoperative follow-up.
Results A total of 25,403 patients with median age of 52 years (18–92) who underwent ACDF
met the inclusion criteria. Breakdown of the four cohorts was as follows: prior nondependent
who remain nondependent (NDND): 62.76% (n = 15,944); prior nondependent who become dependent (NDD): 4.6% (n = 1,168); prior dependent who become nondependent (DND): 14.03% (n = 3,564); and prior dependent who remain dependent (DD): 18.61% (n = 4,727). Opioid dependence decreased 9.43% postoperatively. Overall payments and
30-day readmissions increased 1.96 and 1.79 times for opioid dependent versus nondependent
cohorts, respectively. Adjusted payments at 3 to 15 months were significantly increased
for dependent cohorts with 3.56-fold increase for the DD cohort when compared with
the NDND cohort. Length of stay, complications, medication refills, outpatient measures,
and hospital admissions were also higher in those groups with postoperative opioid
dependence when compared with those who were not opioid dependent.
Conclusions Opioid dependence after ACDF is associated with increased hospital readmissions,
complication rates at 30 days, and payments within 3 months and 3 to 15 months postdischarge.
Overall opioid dependence was decreased after ACDF procedure, however, a smaller number
of opioid-dependent and opioid-naive patients became dependent postoperatively and
should be followed carefully.
Keywords
ACDF - opioids - opioid dependence - analgesia - spine surgery
