Association Between Postoperative Physical Therapy and Opioid Prescription After Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study of United States Academic Health Centers.

Abstract

Retrospective cohort. We investigated whether postoperative physical therapy (PT) significantly reduces the risk and amount of oral opioid prescriptions in the first year after primary anterior cervical discectomy and fusion (ACDF) and the risk of any opioid prescription/administration. There is a need for nonopioid pain management strategies following ACDF in light of the opioid epidemic. We utilized deidentified medical records from the TriNetX network to identify opioid-naïve adults undergoing their first ACDF from 2014 to 2023. Patients were divided into cohorts by the presence or absence of postoperative PT (≤2 mo post-ACDF) and propensity matched for variables related to opioid prescription. Primary outcomes were risk ratio (RR) and the mean number of oral opioid prescriptions in the first postoperative year. Secondary outcomes included the cumulative incidence and risk of any opioid prescription/administration. Each cohort had 4864 patients after propensity matching. Patients receiving PT had a significantly lower risk of oral opioid prescription in the first year after primary ACDF compared with patients not receiving PT [RR: 0.739 (0.714, 0.765); 48.8% vs. 66.1%; P<0.0001]. Patients receiving PT had a statistically significant lower risk of any-route opioid prescription in the first year after primary ACDF as compared with patients who did not receive PT [RR: 0.801 (0.782, 0.821); 65.7% vs. 82.0%; P<0.0001]. In addition, the mean instances of prescriptions per patient were lower for oral opioids (1.9 vs. 2.2; P=0.006) and any-route opioids (2.8 vs. 3.1; P=0.004) among patients receiving PT versus patients not receiving PT within 2 months. Postoperative PT is associated with significantly lowered risk and mean opioid prescriptions in the first year after primary ACDF. Further investigation is needed to understand PT's role in reducing opioid use. Level II.