Department of Neurosurgery, Cleveland Clinic, Cleveland, OH.
Department of Neurosurgery, University of Texas, Southwestern Medical Center, Dallas, TX.
Clin Spine Surg. 2021 Mar 1;34(2):E86-E91. doi: 10.1097/BSD.0000000000001053.
A retrospective cohort study.
To compare the postoperative opioid utilization rates and costs after anterior cervical discectomy and fusion (ACDF) procedures between groups of patients who were preoperative opioid users versus opioid naive.
Opioid medications are frequently prescribed after ACDF procedures. Given the current opioid epidemic, there is increased emphasis on early identification of patients at risk for prolonged postoperative opioid use.
Records from patients diagnosed with cervical stenosis who underwent a ≤3-level index ACDF surgery between 2007 and 2017 were collected from a large insurance database. International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and generic drug codes were used to search clinical records. Two cohorts were established: a group of patients who utilized opioids preoperatively and a group of patients who were opioid naive at the time of surgery. The 1-year utilization and costs of postoperative therapies were documented for each group.
The preoperative opioid use cohort contained 4485 patients (61.6%), whereas the opioid-naive cohort included 2799 patients (38.4%). Postoperatively, 86.6% of the preoperative opioid use group continued to use opioids, whereas 59.0% of the opioid-naive group began using opioids. Patients who utilized opioids preoperatively were 4.48 times more likely (95% confidence interval, 3.99-5.02, P<0.001) to use opioids postoperatively and 4.30 times more likely (95% confidence interval, 3.10-5.94, P<0.001) to become opioid dependent compared with opioid-naive patients. In addition, after normalization, patients in the preoperative opioid use group utilized 3.7 times more opioid units/patient and billed for 5.3 times more dollars/patient than opioid-naive patients.
In patients with cervical stenosis who undergo an ACDF procedure, the postoperative utilization and costs of opioids seem to be substantially higher in patients with preoperative opioid use compared with opioid-naive patients. Efforts should be made to avoid opioid use as a component of conservative management before surgery.
Level III.
回顾性队列研究。
比较术前使用阿片类药物和未使用阿片类药物的患者在接受颈椎前路椎间盘切除融合术（ACDF）后的术后阿片类药物使用率和成本。
阿片类药物在 ACDF 手术后经常被开处。鉴于当前阿片类药物流行，人们越来越强调早期识别有长期术后阿片类药物使用风险的患者。
从一家大型保险公司的数据库中收集了 2007 年至 2017 年间诊断为颈椎狭窄并接受≤3 级指数 ACDF 手术的患者记录。使用国际疾病分类诊断/程序代码、当前程序术语代码和通用药物代码搜索临床记录。建立了两个队列：一组术前使用阿片类药物的患者和一组手术时未使用阿片类药物的患者。记录了每个组的 1 年术后治疗的使用情况和费用。
术前使用阿片类药物的队列包含 4485 名患者（61.6%），而未使用阿片类药物的队列包括 2799 名患者（38.4%）。术后，术前使用阿片类药物组 86.6%的患者继续使用阿片类药物，而未使用阿片类药物组 59.0%的患者开始使用阿片类药物。与未使用阿片类药物的患者相比，术前使用阿片类药物的患者术后使用阿片类药物的可能性高 4.48 倍（95%置信区间，3.99-5.02，P<0.001），且成为阿片类药物依赖者的可能性高 4.30 倍（95%置信区间，3.10-5.94，P<0.001）。此外，经过标准化后，术前使用阿片类药物组的患者每个患者使用的阿片类药物单位多 3.7 倍，每个患者的费用多 5.3 倍。
在接受 ACDF 手术的颈椎狭窄患者中，与未使用阿片类药物的患者相比，术前使用阿片类药物的患者术后阿片类药物的使用和费用似乎明显更高。应努力避免在手术前将阿片类药物作为保守治疗的一部分。
3 级。
