Burden of Pre-operative Opioid Use and Its Impact on Healthcare Utilization After Primary Single Level Lumbar Discectomy.

Abstract Background Context The complication profile and higher cost of care associated with pre-operative opioid use and spinal fusion is well described. However, the burden of opioid use and its impact in patients undergoing lumbar discectomy is not known. Knowledge of this, especially for a relatively benign and predictable procedure will be important in bundled and value-based payment models. Purpose To study the burden of pre-operative opioid use and its effect on post-operative healthcare utilization, cost, and opioid use in patients undergoing primary single level lumbar discectomy. Study Design Retrospective cohort study Patient Sample 29,745 patients undergoing primary single level lumbar discectomy from the IBM® MarketScan® (2000-2018) database. Outcome Measures 90-day and 1-year utilization of lumbar epidural steroid injections (ESIs), emergency department (ED) services, lumbar magnetic resonance imaging (MRI), hospital readmission, and revision lumbar surgery. Continued opioid use beyond 3-months post-operatively until 1-year was also studied. We have reported costs associated with healthcare utilization among opioid groups. Methods Patients were categorized in opioid use groups based on the duration and number of oral prescriptions prior to discectomy (opioid naive, Results A total of 29,745 patients with mean age of 45.3± 9.6 years were studied. Pre-operatively, 29.0% were opioid naive, 35.0% had Conclusion Chronic pre-operative opioid use was present in 12% of a national cohort of lumbar discectomy patients. Such opioid use was associated with significantly higher post-operative healthcare utilization, risk of revision surgery, and costs at 90-days and 1-year post-operatively. Two-third of chronic pre-operative opioid users had continued long-term post-operative opioid use. However, a 3-month prescription free period before surgery in chronic opioid users reduces the risk of long-term post-operative use. This data will be useful for patient education, pre-operative opioid use optimization, and risk-adjustment in value-based payment models.