Risks Associated with Opioids after Spine Surgery

The use of intravenous narcotics is the common pain management protocol following spine surgery. These drugs can cause respiratory problems, nausea, vomiting, and other opioid-related adverse events (ORAE). Statistically, ORAEs cause longer hospital stays and/or readmissions, which translates into higher health care costs.
Lumbar spine surgery is common and the postoperative standard of care includes opioids administered intravenously for management of pain.Lumbar spine surgery is common and the postoperative standard of care includes opioids administered intravenously for management of pain. Dr. Polly stated, “About a quarter of the unplanned readmissions are due to the pain control … and in our pain management strategy, it is probably PCA with opioid medications.”

The goal of this study was to conduct a database review to examine the frequency/occurrence of ORAEs in patients who undergo lumbar spine surgery.

Methods
The study used Medicare Part B claims data for the period 2010-2012 and CPT-4 codes. Dr. Polly explained, “Now, an appropriate limitation of this methodology is we cannot tell you that each and every one of these codes were caused specifically by the postoperative opioid medication, although there is a modest probability that they were, and so that is the limitation of the database study.”

Certain patients were excluded from the study:

• Patients with less than one year of claim history
• Patients under age 65

The total of Medicare patients identified in this study:

• 24,514 lumbar laminectomy
• 16,765 posterior lumbar fusion

Ninety days after surgery the rate of newly-diagnosed opioid-related adverse events was evaluated using ICD-9 diagnostic codes. The study reviewed respiratory problems, paralytic ileus, postoperative nausea and vomiting, acute delirium, urinary retention, constipation and other opioid-related complications. Patients were excluded if their complications were considered to be pre-existing. Furthermore, multivariate Cox regression was utilized to assess risk factors for ORAEs. The study also considered patient age, socioeconomic status, gender, race, year surgery was performed, and other factors.

Conclusion
Dr. Polly concluded, "Opioids are effective, they are the most common strategy for postoperative pain management; however, this does come with associated risks. These can increase health care costs as well as complications.” Furthermore, Dr. Polly indicated there is a need to find a better way to control postoperative pain.