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Abstract
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OBJECTIVE: Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in post-operative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York's 2016 State legislation limiting opioid prescriptions.
METHODS: Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009-2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department (ED) for acute opioid poisoning post-operatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c), limiting opioid analgesic prescriptions, was also evaluated by comparing rates of poisoning pre- and post-legislation enactment.
RESULTS: 107,456 spine patients were identified and 321 (0.3%) presented post-operatively to the ED with acute opioid poisoning. Increased age (OR=0.954, P<0.0001) had a decreased likelihood of poisoning. Other race (OR=1.322, P=0.0167), Medicaid (OR=2.079, P<0.0001), Medicare (OR=2.9, P<0.0001), comorbidities (OR=3.271, P<0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P<0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of post-operative acute opioid poisoning in patients receiving procedures post-legislation with reduced overall likelihood (OR=0.28, P<0.0001).
CONCLUSION: There is a higher than national average rate of acute opioid poisonings following spine procedures and an increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of post-operative opioid poisoning to promote appropriate management of post-surgical pain.
Language: en |