Preoperative opiate use leads to increased postoperative opiate use and readmissions after anterior cervical discectomy and fusion
Background: Determine effects of pre-operative opiate use on anterior cervical discectomy and fusion (ACDF) surgery outcomes. Methods: The study design was a single center retrospective cohort study. Patient records were reviewed from 2013 and 2018 for elective 1 to 2 level ACDF surgeries. Patients were classified as: opiate naive (ON: no history of opiate) use, acute opiate (AO: <6 months preoperatively) use, and chronic opiate (CO: 6–12 months preoperatively) use based on prescription history before surgery. Opiate use was quantified by milligram morphine equivalents (MME) at 6–12 months preop, 0–6 months preop, 0-6 months postop, and 6–12 months postop. Charts were reviewed for American Society of Anesthesiologists (ASA) physical status classification and smoking history. Results: Readmission rates were 9.8% for ON, 9.1% for AO, and 30% for CO (P value <0.05). Average opiate use measured in MME 6-12 months post-surgery was 5.76 for ON, 18.44 for AO, and 39.92 for CO (P value <0.05). Readmission rate between nonsmokers, former smokers, and active smokers was 4.4%, 0%, and 10.8% (P value <0.05) at 30–90 days post-surgery, and 1.1%, 14.5%, and 2.5% (P value <0.05) in the 91 days to 1-year post-surgery. Conclusions: There is statistically significant relationship between CO and higher readmission rates after ACDF. Preoperative opiate use is also associated with increased opiate use 6–12 months after surgery. Smoking history is also associated with increased readmission rates.
