Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration
ABSTRACT: Background: The United States Veteran Health Administration (VHA) cares for a substantial group of patients who are at higher risk of substance abuse in comparison to the general population. The purpose of this study was to (1) examine opioid consumption in the veteran population both pre...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | North American Spine Society Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548425000150 |
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| author | Andrew M. Gabig, MD Paymon G. Rezaii, MS Sean C. Clark, MS Bela P. Delvadia, BS Olivia C. Lee, MD William F. Sherman, MD, MBA Mathew Cyriac, MD, MBA |
| author_facet | Andrew M. Gabig, MD Paymon G. Rezaii, MS Sean C. Clark, MS Bela P. Delvadia, BS Olivia C. Lee, MD William F. Sherman, MD, MBA Mathew Cyriac, MD, MBA |
| author_sort | Andrew M. Gabig, MD |
| collection | DOAJ |
| description | ABSTRACT: Background: The United States Veteran Health Administration (VHA) cares for a substantial group of patients who are at higher risk of substance abuse in comparison to the general population. The purpose of this study was to (1) examine opioid consumption in the veteran population both pre- and postoperatively to anterior cervical discectomy and fusion (ACDF) and (2) understand the risk factors that are associated with sustained postoperative opioid use. Methods: A retrospective database study was conducted using the Veterans Affairs Informatics and Computing Infrastructure database. Patients who underwent ACDF between 2010 and 2020 were identified and stratified into 3 groups based on their preoperative opioid usage prior to the procedure: opioid naïve, low preoperative opioid use (1-3 preoperative claims), and high preoperative opioid use (≥4 preoperative claims). Cumulative pre- and postoperative opioid usage for each patient was calculated in Morphine Milligram Equivalents (MME). Results: A total of 7,894 patients were identified with 3,929 (49.7%) opioid naïve, 1,813 (23.0%) low preoperative opioid use, and 2,152 (27.3%) high opioid usage. The proportion of patients in the opioid-naïve cohort, low preoperative usage cohort, and high preoperative opioid usage cohort, that remained on opioids 1 year postoperatively was 13.1%, 31.3%, and 77.8%, respectively. At 1 year postoperatively, the median opioid MME significantly decreased pre- to postoperatively (25.0 vs. 0, p<.006). High preoperative opioid consumption was found to be the greatest risk factor for continued chronic opioid use (OR 17.1, p<.001) Conclusions: Following ACDF procedures, opioid consumption significantly decreased; however, at 1 year, over one-third of patients remained on opioid therapy. A disproportionate number of patients who remained on chronic opioid therapy had high preoperative opioid consumption. Notably, increased scrutiny and policy changes regarding opioids, which began around 2017, resulted in a significant reduction in preoperative opioid use by 2020 compared to a decade earlier. |
| format | Article |
| id | doaj-art-06fc4eaf0feb45bead00127bdcd6523e |
| institution | Kabale University |
| issn | 2666-5484 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | North American Spine Society Journal |
| spelling | doaj-art-06fc4eaf0feb45bead00127bdcd6523e2025-08-20T03:24:08ZengElsevierNorth American Spine Society Journal2666-54842025-06-012210059510.1016/j.xnsj.2025.100595Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health AdministrationAndrew M. Gabig, MD0Paymon G. Rezaii, MS1Sean C. Clark, MS2Bela P. Delvadia, BS3Olivia C. Lee, MD4William F. Sherman, MD, MBA5Mathew Cyriac, MD, MBA6Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United StatesDepartment of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, LA, United States; Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United StatesDepartment of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United States; Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United States; Corresponding author. Department of Orthopaedic Surgery, Tulane University, 1430 Tulane Ave., New Orleans, LA 70112, USA.Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, United States; Department of Orthopaedic Surgery, Southeast Louisiana Veterans Health Care System, New Orleans, LA, United StatesABSTRACT: Background: The United States Veteran Health Administration (VHA) cares for a substantial group of patients who are at higher risk of substance abuse in comparison to the general population. The purpose of this study was to (1) examine opioid consumption in the veteran population both pre- and postoperatively to anterior cervical discectomy and fusion (ACDF) and (2) understand the risk factors that are associated with sustained postoperative opioid use. Methods: A retrospective database study was conducted using the Veterans Affairs Informatics and Computing Infrastructure database. Patients who underwent ACDF between 2010 and 2020 were identified and stratified into 3 groups based on their preoperative opioid usage prior to the procedure: opioid naïve, low preoperative opioid use (1-3 preoperative claims), and high preoperative opioid use (≥4 preoperative claims). Cumulative pre- and postoperative opioid usage for each patient was calculated in Morphine Milligram Equivalents (MME). Results: A total of 7,894 patients were identified with 3,929 (49.7%) opioid naïve, 1,813 (23.0%) low preoperative opioid use, and 2,152 (27.3%) high opioid usage. The proportion of patients in the opioid-naïve cohort, low preoperative usage cohort, and high preoperative opioid usage cohort, that remained on opioids 1 year postoperatively was 13.1%, 31.3%, and 77.8%, respectively. At 1 year postoperatively, the median opioid MME significantly decreased pre- to postoperatively (25.0 vs. 0, p<.006). High preoperative opioid consumption was found to be the greatest risk factor for continued chronic opioid use (OR 17.1, p<.001) Conclusions: Following ACDF procedures, opioid consumption significantly decreased; however, at 1 year, over one-third of patients remained on opioid therapy. A disproportionate number of patients who remained on chronic opioid therapy had high preoperative opioid consumption. Notably, increased scrutiny and policy changes regarding opioids, which began around 2017, resulted in a significant reduction in preoperative opioid use by 2020 compared to a decade earlier.http://www.sciencedirect.com/science/article/pii/S2666548425000150(ACDF)Anterior cervical discectomy and fusionCervical spine(MME)Morphine Milligram EquivalentsOpioids |
| spellingShingle | Andrew M. Gabig, MD Paymon G. Rezaii, MS Sean C. Clark, MS Bela P. Delvadia, BS Olivia C. Lee, MD William F. Sherman, MD, MBA Mathew Cyriac, MD, MBA Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration North American Spine Society Journal (ACDF) Anterior cervical discectomy and fusion Cervical spine (MME) Morphine Milligram Equivalents Opioids |
| title | Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration |
| title_full | Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration |
| title_fullStr | Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration |
| title_full_unstemmed | Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration |
| title_short | Trends of opioid use following anterior cervical discectomy and fusion: A 10-year longitudinal study of the Veterans Health Administration |
| title_sort | trends of opioid use following anterior cervical discectomy and fusion a 10 year longitudinal study of the veterans health administration |
| topic | (ACDF) Anterior cervical discectomy and fusion Cervical spine (MME) Morphine Milligram Equivalents Opioids |
| url | http://www.sciencedirect.com/science/article/pii/S2666548425000150 |
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