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Does a High Postoperative Opioid Dose Predict Chronic Use After ACDF?

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High postoperative opioid doses predict chronic opioid use after anterior cervical diskectomy and fusion (ACDF), even with prior opioid tolerance. This finding is crucial for managing long-term pain medication needs post-surgery.

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Area of Science:

  • Neurosurgery
  • Pain Management
  • Pharmacology

Background:

  • Chronic opioid use is a significant concern following spinal surgery.
  • Anterior cervical diskectomy and fusion (ACDF) is a common procedure for degenerative cervical spine diseases.
  • Identifying predictors of chronic opioid use is essential for effective patient management.

Purpose of the Study:

  • To investigate whether increased postoperative opioid dosing is an independent predictor of chronic opioid use after ACDF.
  • To analyze the relationship between preoperative factors and postoperative opioid consumption.
  • To determine the isolated impact of high opioid doses on long-term opioid use.

Main Methods:

  • Retrospective cohort analysis of 385 patients undergoing ACDF for degenerative diseases (2016-2019).
  • Data on opioid and benzodiazepine prescriptions (MMEs, duration) were obtained from the Pennsylvania Prescription Drug Monitoring Program.
  • Logistic regression models identified predictors of high postoperative opioid dose and chronic opioid use.

Main Results:

  • Preoperative opioid tolerance and tobacco use were linked to higher postoperative opioid doses and chronic use.
  • Younger age, increased BMI, and preoperative benzodiazepine use were also associated with chronic opioid use.
  • High postoperative opioid dose, opioid tolerance, increased BMI, and no prior cervical surgery predicted chronic opioid use.

Conclusions:

  • Increased postoperative opioid dosing is an independent predictor of chronic opioid use after ACDF.
  • This association holds true irrespective of a patient's preoperative opioid tolerance.
  • Findings highlight the importance of monitoring postoperative opioid prescriptions to mitigate long-term use.