Relationship between initial opioid prescription size and likelihood of refill after spine surgery.

Best practices in opioid prescribing after elective surgery have been developed for most surgical subspecialties, including spine. However, some percentage of patients will become chronic users. This study aimed to determine the relationship between the size of initial opioid prescription after surgery for degenerative spinal disease and the likelihood of refills. Retrospective case-control study. Opioid-naïve patients aged 18 to 64 undergoing elective spinal procedures (anterior cervical discectomy and fusion, posterior cervical fusion, lumbar decompression, and lumbar fusion) from 2010 to 2015 filling an initial perioperative prescription using insurance claims from Truven Health MarketScan (n=25,329). Functional measure: health-care utilization. Primary outcome was occurrence of an opioid refill within 30 postoperative days. We used logistic regression to examine the probability of an additional refill by initial opioid prescription strength, adjusting for patient factors. About 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery. The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories. Patient factors associated with increased likelihood of refills included age 30 to 39 years (odds ratio [OR] 1.137, p=.007, 95% confidence interval [CI] 1.072-1.249), female gender (OR 1.137, p<.001, 95% CI 1.072-1.207), anxiety disorder (OR 1.141, p=.017, 95% CI 1.024-1.272), mood disorder (OR 1.109 p=.049, 95% CI 1.000-1.229), and history of alcohol/substance abuse (OR 1.445 p=.006, 95% CI 1.110-1.880). For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.

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