New Data on Opioid Dependence in Surgical Patients

How does the use of opioids affect patients after surgery for degenerative spondylolisthesis (DS)?

This was the question researchers were asking in their recent study, “Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis.” The study appears in the May 2018 edition of Journal of Neurosurgery.

According to the study, “…The authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions.”

Co-author Beatrice Ugiliweneza, University of Louisville, Department of Health Management and Systems Science, Department of Neurosurgery, told OTW, “Low back pain has taken center stage in recent years and research on evidence of best treatment options is still on-going.”

“One of the frequent causes of low back pain is degenerative spondylolisthesis. For degenerative spondylolisthesis, surgery has been found to be superior in outcomes. To manage the pain prior- or post- surgery, opioids are used in high prevalence. In recent decades however, more and more patients overuse opioids leading to dependence and abuse which has resulted in a national crisis.”

“In our recent work, we have found that surgery for degenerative spondylolisthesis is associated with reduced odds of opioid dependence and that patients who undergo surgery are more likely to become opioid independent than they are to become opioid dependent. A question remained, however, of how that translated into health resources use and cost.”

“We found that patients who are opioid dependent post-surgery have significantly more healthcare utilization and incur significantly more cost both within 3 months of discharge and in the 12 months after that (3-15 months after surgery) compared to prior non-dependent who remained non-dependent after surgery.”

“This work suggests that, although patients with degenerative spondylolisthesis undergoing surgery are likely to become opioid independent, those who remain opioid dependent or become dependent need to be closely monitored.”

“Spine surgeons should keep in mind that about 10% of their surgical degenerative spondylolisthesis patients are likely to be opioid dependent post-surgery (~4% prior non-dependent and ~6% prior dependent).”

“As a result, these patients will have more healthcare utilization which will carry a heavy cost burden. Therefore, it would be helpful to have systems and awareness to know who is at high risk to be opioid dependent after surgery. It is particularly important in this era of bundled payment and value-based reimbursements.”