Regional Variation in Opioid Use After Lumbar Spine Surgery

Owoicho Adogwa, Mark A. Davison, Victoria D. Vuong, Shyam A. Desai, Daniel T. Lilly, Jessica Moreno, Joseph Cheng, Carlos A Bagley

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to investigate regional variations in use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6 months before index surgery to 2 years after surgery was assessed. Results: Of the 13,257 patients included in the study, 63.1% were from the South, 24.3% from the Midwest, 10.5% from the West, and 2.1% from the Northeast. Of patients, 57.8% had a history of opioid use before index surgery, of whom 64.4% were from the South and 23.0% from the Midwest. Over the 6-month preoperative period, 51.6 opioid pills were billed by opioid users monthly (Midwest, 52.7 pills/patient/month; Northeast, 64.9 pills/patient/month; South, 50.6 pills/patient/month; West, 52.2 pills/patient/month). During the 2-year period after surgery, an average of 33.6 opioid pills were billed by opioid users monthly (Midwest, 32.9 pills/patient/month; Northeast, 35.4 pills/patient/month; South, 33.9 pills/patient/month; West, 32.9 pills/patient/month). In a multivariate logistic regression analysis, receiving treatment in the South (odds ratio, 1.18; 95% confidence interval, 1.07–1.29) or West (odds ratio, 1.26; 95% confidence interval, 1.10–1.45) was independently associated with prolonged (>1 year) opioid use after index surgery. Conclusions: Our study suggests that regional variations may exist in the use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Opioid Analgesics
Spine
Decompression
Spondylolisthesis
Pathologic Constriction
Medicare Part C
Odds Ratio
Confidence Intervals
Generic Drugs
Preoperative Period
International Classification of Diseases
Insurance
Logistic Models
Regression Analysis
Databases

Keywords

  • Lumbar decompression
  • Lumbar spondylolisthesis
  • Lumbar stenosis
  • Lumbar surgery
  • Opioid use
  • Regional variation
  • Symptomatic lower back pain

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Adogwa, O., Davison, M. A., Vuong, V. D., Desai, S. A., Lilly, D. T., Moreno, J., ... Bagley, C. A. (Accepted/In press). Regional Variation in Opioid Use After Lumbar Spine Surgery. World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.09.192

Regional Variation in Opioid Use After Lumbar Spine Surgery. / Adogwa, Owoicho; Davison, Mark A.; Vuong, Victoria D.; Desai, Shyam A.; Lilly, Daniel T.; Moreno, Jessica; Cheng, Joseph; Bagley, Carlos A.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Adogwa, O, Davison, MA, Vuong, VD, Desai, SA, Lilly, DT, Moreno, J, Cheng, J & Bagley, CA 2018, 'Regional Variation in Opioid Use After Lumbar Spine Surgery', World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.09.192
Adogwa O, Davison MA, Vuong VD, Desai SA, Lilly DT, Moreno J et al. Regional Variation in Opioid Use After Lumbar Spine Surgery. World Neurosurgery. 2018 Jan 1. https://doi.org/10.1016/j.wneu.2018.09.192
Adogwa, Owoicho ; Davison, Mark A. ; Vuong, Victoria D. ; Desai, Shyam A. ; Lilly, Daniel T. ; Moreno, Jessica ; Cheng, Joseph ; Bagley, Carlos A. / Regional Variation in Opioid Use After Lumbar Spine Surgery. In: World Neurosurgery. 2018.
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abstract = "Objective: The aim of this study was to investigate regional variations in use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6 months before index surgery to 2 years after surgery was assessed. Results: Of the 13,257 patients included in the study, 63.1{\%} were from the South, 24.3{\%} from the Midwest, 10.5{\%} from the West, and 2.1{\%} from the Northeast. Of patients, 57.8{\%} had a history of opioid use before index surgery, of whom 64.4{\%} were from the South and 23.0{\%} from the Midwest. Over the 6-month preoperative period, 51.6 opioid pills were billed by opioid users monthly (Midwest, 52.7 pills/patient/month; Northeast, 64.9 pills/patient/month; South, 50.6 pills/patient/month; West, 52.2 pills/patient/month). During the 2-year period after surgery, an average of 33.6 opioid pills were billed by opioid users monthly (Midwest, 32.9 pills/patient/month; Northeast, 35.4 pills/patient/month; South, 33.9 pills/patient/month; West, 32.9 pills/patient/month). In a multivariate logistic regression analysis, receiving treatment in the South (odds ratio, 1.18; 95{\%} confidence interval, 1.07–1.29) or West (odds ratio, 1.26; 95{\%} confidence interval, 1.10–1.45) was independently associated with prolonged (>1 year) opioid use after index surgery. Conclusions: Our study suggests that regional variations may exist in the use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.",
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AU - Lilly, Daniel T.

AU - Moreno, Jessica

AU - Cheng, Joseph

AU - Bagley, Carlos A

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N2 - Objective: The aim of this study was to investigate regional variations in use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6 months before index surgery to 2 years after surgery was assessed. Results: Of the 13,257 patients included in the study, 63.1% were from the South, 24.3% from the Midwest, 10.5% from the West, and 2.1% from the Northeast. Of patients, 57.8% had a history of opioid use before index surgery, of whom 64.4% were from the South and 23.0% from the Midwest. Over the 6-month preoperative period, 51.6 opioid pills were billed by opioid users monthly (Midwest, 52.7 pills/patient/month; Northeast, 64.9 pills/patient/month; South, 50.6 pills/patient/month; West, 52.2 pills/patient/month). During the 2-year period after surgery, an average of 33.6 opioid pills were billed by opioid users monthly (Midwest, 32.9 pills/patient/month; Northeast, 35.4 pills/patient/month; South, 33.9 pills/patient/month; West, 32.9 pills/patient/month). In a multivariate logistic regression analysis, receiving treatment in the South (odds ratio, 1.18; 95% confidence interval, 1.07–1.29) or West (odds ratio, 1.26; 95% confidence interval, 1.10–1.45) was independently associated with prolonged (>1 year) opioid use after index surgery. Conclusions: Our study suggests that regional variations may exist in the use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.

AB - Objective: The aim of this study was to investigate regional variations in use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients undergoing 1-level, 2-level, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Research records were searchable by International Classification of Diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6 months before index surgery to 2 years after surgery was assessed. Results: Of the 13,257 patients included in the study, 63.1% were from the South, 24.3% from the Midwest, 10.5% from the West, and 2.1% from the Northeast. Of patients, 57.8% had a history of opioid use before index surgery, of whom 64.4% were from the South and 23.0% from the Midwest. Over the 6-month preoperative period, 51.6 opioid pills were billed by opioid users monthly (Midwest, 52.7 pills/patient/month; Northeast, 64.9 pills/patient/month; South, 50.6 pills/patient/month; West, 52.2 pills/patient/month). During the 2-year period after surgery, an average of 33.6 opioid pills were billed by opioid users monthly (Midwest, 32.9 pills/patient/month; Northeast, 35.4 pills/patient/month; South, 33.9 pills/patient/month; West, 32.9 pills/patient/month). In a multivariate logistic regression analysis, receiving treatment in the South (odds ratio, 1.18; 95% confidence interval, 1.07–1.29) or West (odds ratio, 1.26; 95% confidence interval, 1.10–1.45) was independently associated with prolonged (>1 year) opioid use after index surgery. Conclusions: Our study suggests that regional variations may exist in the use of opioids after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.

KW - Lumbar decompression

KW - Lumbar spondylolisthesis

KW - Lumbar stenosis

KW - Lumbar surgery

KW - Opioid use

KW - Regional variation

KW - Symptomatic lower back pain

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