Long-term opioid prescriptions following spine surgery: A meta-analysis of prevalence and risk factor

Abstract Background Opioids are frequently prescribed for back pain, but the prevalence of and risk factors for long-term opioid utilization post-spine surgery were not clearly reported. We conducted a systematic review and meta-analysis to summarize these evidences for long-term opioid use (>90 days) among adults who underwent spine surgery. Methods PubMed, EMBASE and Cochrane indexing databases were searched through 11/09/2018 for studies reporting the prevalence of and risk factors for long-term opioid use post-spine surgery. Separate meta-analyses were conducted for commercial claims databases or registries (“claims/registries”) and “non-claims” observational studies using the random-effects model to estimate the pooled odds ratio (OR). Prevalence meta-analysis was performed in a clinically homogeneous subset of these patients who underwent lumbar spine surgery. Results Eight claims and five non-claims were meta-analyzed to avoid double-counting participants. The meta-analysis revealed that preoperative opioid users (OR 5.59, 95% CI: 3.37-9.27; vs. OR 4.21, 2.72-6.51) and participants with pre-existing depression and/or anxiety (OR 1.86, 1.43-2.42; OR 1.20, 0.83-1.74) had a statistically significantly higher odds of long-term postoperative opioids, when compared to their peers. Males showed lower odds of long-term postoperative opioid use in the claims group (OR 0.85, 0.79-0.92), but not in the non-claims group (OR 0.99, 0.71-1.39). The pooled prevalence of post-lumbar spine surgery long-term opioid use was 63% (50-74%) in claims and 47% (38-56%) in non-claims. Conclusions Spine surgery patients represent a high-risk surgical population requiring special attention and targeted interventions, with the strongest evidence for those treated with opioids before surgery and those with psychiatric comorbidities.