Skip to main content
  • Factors Predicting Opioid Dependence in Patients Undergoing Surgery for Degenerative Spondylolisthesis: Analysis from Market Scan Database

    Final Number:

    Mayur Sharma MD MCh; Beatrice Ugiliweneza MSPH; Zaid Aljuboori MD; Miriam Nuno PhD; Doniel Drazin; Maxwell Boakye MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Background: The aim of our study was to identify risk factors associated with opioid dependency in patients undergoing surgery for Degenerative Spondylolisthesis (DS).

    Methods: We queried the Market Scan database to investigate factors affecting post-surgery opioid use from 2000-2012. The outcome of interest was opioid dependency and defined as continued opioid use or >10 opioid prescriptions, diagnosis of or prescription for opioid dependency disorder in the period of one year prior to or in the period of 3-15 months following the procedure. Comparisons of outcomes were performed using non-parametric 2-group tests and generalized regression models.

    Results: A cohort of 10708 was identified from the database. A majority of patients were females (n=6975, 65.1%) and median age was 61 years (range 54-69 years). A majority of patients had decompression with fusion (n=10068, 94%) and had multilevel procedures (n=8123, 75.9%). 14.85% (n=1591) of patients were identified to have opioid dependency within 12 months prior to the index surgical procedure and 9.90% (n=1060) were identified to have opioid dependency within 3-15 months after the procedure. Of all the variables, prior opioid dependency (OR: 16.29; 95% CI: 14.10, 18.81; p<0.001) and young age (1-year increase in age, OR: 0.972; 95% CI: 0.963-0.980; p<0.001) were independent predictors of opioid dependency following surgery for DS. The use of fusion was not associated with opioid dependency following the procedure (p=0.8396). Following surgery for DS, patients were likely to become opioid independent than they are to become dependent (8.54% vs. 3.58%, p <0.001).

    Conclusions: The majority of patients underwent fusion for DS. Surgical decompression with fusion was not associated with increased risk of post-surgery opioid dependency in patients with DS. Overall, opioid dependence was reduced by 4.96% after surgery for DS. Prior opioid dependency in a young patient is associated with increased risk of opioid dependency following surgery for DS.

    Patient Care: We believe that by identifying the risk factors which are predictive of long-term opioid dependency in patients with DS, may assist in taking necessary steps in curtailing this opioid epidemic.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify the risk factors associated with opioid dependency following surgery for degenerative spondylolisthesis. 2) Describe the impact of surgery on opioid dependency in patients with DS.3) Discuss the national trends and health care burden associated with opioid dependency in this patient cohort.

    References: 1. Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ: Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 24:479-484, 2011 2. Ambekar S, Sharma M, Kukreja S, Nanda A: Complications and outcomes of surgery for spinal meningioma: a Nationwide Inpatient Sample analysis from 2003 to 2010. Clin Neurol Neurosurg 118:65-68, 2014 3. Armaghani SJ, Lee DS, Bible JE, Archer KR, Shau DN, Kay H, et al: Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine (Phila Pa 1976) 39:E1524-1530, 2014 4. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al: New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg 152:e170504, 2017 5. Cepeda MS, Fife D, Ma Q, Ryan PB: Comparison of the risks of opioid abuse or dependence between tapentadol and oxycodone: results from a cohort study. J Pain 14:1227-1241, 2013 6. Connolly J, 3rd, Javed Z, Raji MA, Chan W, Kuo YF, Baillargeon J: Predictors of Long Term Opioid Use following Lumbar Fusion Surgery. Spine (Phila Pa 1976), 2017 7. Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI: United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 30:1441-1445; discussion 1446-1447, 2005 8. Elixhauser A, Steiner C, Harris DR, Coffey RM: Comorbidity measures for use with administrative data. Med Care 36:8-27, 1998 9. Finucane T, Christmas C, Travis K: Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 282:1365 - 1370, 1999 10. Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, et al: A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med 374:1413-1423, 2016 11. Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, et al: Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis. N Engl J Med 374:1424-1434, 2016 12. Hansen LG, Chang S: Health Research Data for the Real world: The Thomson Reuters MarketScan Databases. The MarketScan Databases (White papers), 2012 13. Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P: Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976) 32:120-125, 2007 14. Johnson J: Trump says opioid crisis is a national emergency, pledges more money and attention, in The Washington Post: The Washington Post, 2017 15. Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, et al: National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 39:1584-1589, 2014 16. Littell RC, Stroup WW, Freund RJ: SAS for Linear Models, ed Fourth. Cary, NC: SAS Institute Inc., 2002 17. Logan J, Liu Y, Paulozzi L, Zhang K, Jones C: Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse. Med Care 51:646-653, 2013 18. Martin BC, Fan MY, Edlund MJ, Devries A, Braden JB, Sullivan MD: Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med 26:1450-1457, 2011 19. Mino DE, Munterich JE, Castel LD: Lumbar fusion surgery for degenerative conditions is associated with significant resource and narcotic use 2 years postoperatively in the commercially insured: a medical and pharmacy claims study. J Spine Surg 3:141-148, 2017 20. Norton RP, Bianco K, Klifto C, Errico TJ, Bendo JA: Degenerative Spondylolisthesis: An Analysis of the Nationwide Inpatient Sample Database. Spine (Phila Pa 1976) 40:1219-1227, 2015 21. Phan K, Rao PJ, Kam AC, Mobbs RJ: Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J 24:1017-1030, 2015 22. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43:1130-1139, 2005 23. Rudd RA, Seth P, David F, L. S: Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep:1445–1452, 2016 24. Schoenfeld AJ, Nwosu K, Jiang W, Yau AL, Chaudhary MA, Scully RE, et al: Risk Factors for Prolonged Opioid Use Following Spine Surgery, and the Association with Surgical Intensity, Among Opioid-Naive Patients. J Bone Joint Surg Am 99:1247-1252, 2017 25. Sharma M, Sonig A, Ambekar S, Nanda A: Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003-2010. J Neurosurg Spine 20:125-141, 2014 26. Stokes M, Davis C, Koch G: Categorical Data Analysis Using the SAS System, ed Second. Cary, NC: SAS Institute Inc., 2000 27. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, et al: Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257-2270, 2007

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy