Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States.
Department of Neurosurgery, University of California Davis, Davis, California, United States.
J Neurol Surg A Cent Eur Neurosurg. 2021 May;82(3):232-240. doi: 10.1055/s-0040-1718759. Epub 2021 Feb 4.
Anterior cervical diskectomy and fusion (ACDF) is a procedure for effectively relieving radiculopathy. Opioids are commonly overprescribed in postsurgical settings and prescriptions vary widely among providers. We identify trends in opioid dependence before and after ACDF.
We used the Truven Health MarketScan data to identify adult patients undergoing ACDF for degenerative cervical spine conditions between 2009 and 2015. Patients were segregated in four cohorts of preoperative and postoperative opioid nondependence (ND) or dependence (D) with 15 months of postoperative follow-up.
A total of 25,403 patients with median age of 52 years (18-92) who underwent ACDF met the inclusion criteria. Breakdown of the four cohorts was as follows: prior nondependent who remain nondependent (NDND): 62.76% ( = 15,944); prior nondependent who become dependent (NDD): 4.6% ( = 1,168); prior dependent who become nondependent (DND): 14.03% ( = 3,564); and prior dependent who remain dependent (DD): 18.61% ( = 4,727). Opioid dependence decreased 9.43% postoperatively. Overall payments and 30-day readmissions increased 1.96 and 1.79 times for opioid dependent versus nondependent cohorts, respectively. Adjusted payments at 3 to 15 months were significantly increased for dependent cohorts with 3.56-fold increase for the DD cohort when compared with the NDND cohort. Length of stay, complications, medication refills, outpatient measures, and hospital admissions were also higher in those groups with postoperative opioid dependence when compared with those who were not opioid dependent.
Opioid dependence after ACDF is associated with increased hospital readmissions, complication rates at 30 days, and payments within 3 months and 3 to 15 months postdischarge. Overall opioid dependence was decreased after ACDF procedure, however, a smaller number of opioid-dependent and opioid-naive patients became dependent postoperatively and should be followed carefully.
颈椎前路椎间盘切除术和融合术（ACDF）是一种有效缓解神经根病的方法。在术后环境中，阿片类药物常常被过度开具处方，而且提供者之间的处方差异很大。我们确定了 ACDF 前后阿片类药物依赖的趋势。
我们使用 Truven Health MarketScan 数据，确定了 2009 年至 2015 年间接受退行性颈椎疾病 ACDF 的成年患者。患者分为术前和术后无依赖（ND）或依赖（D）的四个队列，每个队列有 15 个月的术后随访。
共有 25403 名中位年龄为 52 岁（18-92 岁）的患者符合纳入标准。四个队列的分布如下：术前无依赖且仍无依赖（NDND）：62.76%（ = 15944）；术前无依赖但术后依赖（NDD）：4.6%（ = 1168）；术前依赖但术后无依赖（DND）：14.03%（ = 3564）；术前依赖且术后仍依赖（DD）：18.61%（ = 4727）。术后阿片类药物依赖减少了 9.43%。与无依赖队列相比，依赖队列的总体支付和 30 天再入院率分别增加了 1.96 倍和 1.79 倍。与 NDND 队列相比，DD 队列的调整后支付在 3 至 15 个月时显著增加，为 3.56 倍。与无阿片类药物依赖组相比，术后阿片类药物依赖组的住院时间、并发症发生率、药物续用率、门诊治疗和住院治疗也更高。
ACDF 术后阿片类药物依赖与 30 天内的医院再入院率、并发症发生率以及出院后 3 个月和 3 至 15 个月的支付增加有关。ACDF 手术后总体阿片类药物依赖有所下降，但少数阿片类药物依赖和非依赖患者术后依赖，应密切随访。
