Application of the 2022 CDC Guidelines-Does in-Hospital Opioid Dosage after Lumbar Fusion Affect Long-term Opioid use and Outcomes for Opioid Naïve Patients?

Abstract

Retrospective cohort study. To examine long term opioid use in opioid-naïve patients who received > or <50 morphine milligram equivalents (MME)/day while at the hospital. The 2022 CDC guidelines suggest that >50 MME/day does not provide additional pain/function benefit, but likely increases risks of misuse, overdose and death. To date, there are no studies that examine whether opioid-naïve patients who consume higher quantities of opioids are at increased risk of long-term opioid use. All adult patients with >1 year without opioid use (opioid naïve) who underwent lumbar fusion (2018-2019) were identified. Patients were stratified by > or <50 MME/day during their postoperative inpatient hospital stay. Patients were retrospectively reviewed for demographic and surgical information. Total opioid prescriptions and MME were tracked from one year preoperatively to two years postoperatively, utilizing the Pennsylvania Prescription Drug Monitoring Program. Linear and Poisson regressions were conducted using MME per day within the first 90 days and 90-365 days postoperatively as dependent variables. 143 opioid naïve patients consumed < 50 MME/day, while 180 consumed > 50 MME/day. The >50 MME/day group were younger with lower CCI scores and a shorter length of stay. The >50 MME/day group consumed more MMEs from 0-90 days, and 90-365 days, but were similar after 365 days. Multivariate regression identified CCI and inpatient MME/day as independent predictors of elevated MME within the first year postoperatively. Daily MME consumption after lumbar fusion was an independent predictor of post-discharge MME consumption for up to a year amongst opioid naïve patients. However, higher inpatient opioid consumption does not appear associated with chronic opioid usage beyond one year. Further prospective research should examine the more granular effects that this tradeoff may have to optimize narcotic analgesic risk benefit ratios and to maximize value.