Introduction: There has been an increased utilization of spinal fusion procedures in the United States over the last 30 years. This increased utilization results in increased healthcare cost. Identifying modifiable factors associated with spine surgery outcomes is of increasing importance as healthcare cost containment becomes paramount. As preoperative opioid use increases, so does the need to understand any associated deleterious patient related effects after spinal fusion. We analyzed the relationship between length of stay (LOS), as a metric of health care utilization, with patient characteristics and opioid dependence to identify significant associations.

Methods: A cohort of 1-2 level primary spinal fusion patients with opioid dependence were identified using the National Inpatient Sample (NIS) from 2003-2012 via ICD-9-CM codes. A LOS >75% percentile for our cohort designated significance. Patient and surgical characteristics were analyzed to identify any confounding effects. Univariable and multivariable logistic regression models evaluated associations between opioid dependence and prolonged LOS.

Results: 1,474,076 discharges were identified. 5,599 (0.3%) were opioid dependent. The 75% for LOS was 5 hospital days. A LOS 5 days was considered significant (n=383,775, 26%). Patient and surgical characteristics with the largest impact on the odds ratio of opioid dependence and prolonged LOS are age (OR: 2.77 p<0.000), chronic conditions (2.51 p<0.000), procedure site (OR: 2.33 p<0.000) and procedure year (OR: 2.53 p <0.000). Opioid dependence itself is associated with the greatest odds ratio (OR: 3.00 p <0.000).

Conclusions: Opioid dependence is a modifiable risk factor associated with three times the odds of increased LOS for patients undergoing 1-2 level spinal fusion. Continuing cost constraints require efficient utilization to provide a sustainable healthcare system. As we strive to decrease costs and increase effectiveness of spinal fusions, our study provides evidence of one possible way to preoperatively decrease postoperative health utilization, by decreasing preoperative opioid dependence.

Patient Care: This research will improve patient care by identifying those patients at greatest risk of increased length of postoperative hospitalizations after 1-2 level spinal fusions (and increased cost of providing this care). Additionally, it provides evidence for a modifiable preoperative risk factor (opioid dependence) that may, if addressed, improve both patient rated outcomes after spinal fusion and help control the cost to the healthcare system in providing this service.

Learning Objectives: 1. Preoperative opioid dependence is associated with a significantly longer length of stay in the hospital compared to non-dependent patients. 2. The effect of opioid dependence is greater than age, comorbities, procedure site, and procedure year on length of stay. 3. It is possible to preoperatiely decrease the odds of postoperative length of hospitalization and thus decrease healthcare utilization.

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