Opioid Use After Surgical Intervention for Vertebral Compression Fractures

Most patients who underwent surgical intervention for vertebral compression fractures (VCF) decreased or discontinued opioid prescription fills, according to results of a retrospective analysis, published in Osteoporosis International. This trend of decreased opioid consumption may indicate that there may be an added benefit to surgical intervention for CVF.

Data for this study were sourced from the IBM MarketScanÒ research database which comprises encounter information and inpatient, outpatient, and pharmacy claims of 135 million patients with Medicare Advantage insurance. Adults (N=8845) with a diagnosis of nontraumatic VCF treated with either balloon kyphoplasty (BKP) or vertebroplasty (VP) between 2009 and 2018 were assessed for prescribed opioids, prescription fills, and cost.

Patients had a mean age of 77 years (standard deviation [SD], 12), 73.8% were women, Charlson Comorbidity Index (CCI) was 0 among 58.6%, 30.7% had osteoporosis, 11.9% osteopenia, 4.1% chronic pain disorder, and the time to surgery admission since VCF diagnosis was 22.2 (SD, 43.6) days.

At baseline, 11.1% had no opioid consumption, 38.9% low consumption, 34.1% moderate consumption, and 16.0% high consumption. All characteristics differed significantly on the basis of baseline opioid consumption (all P ≤.0231).

More patients underwent BKP (75.3%) than VP (24.7%).

After BKP or VP, more than half (57.1%) of patients decreased or discontinued filling their opioid prescriptions, 13.9% increased their fills, and 10.9% started a new opioid prescription. At follow-up, the proportion of patients belonging to the no, low, moderate, and high consumption cohorts were 48.6%, 15.7%, 18.1%, and 17.6%, respectively.

During a 2-month window prior to and following BKP or VP, 48.7% of the patients who discontinued filling their opioids were treated an average of 22.1 days prior to and 9.7 days after intervention. Average daily MME was decreased (7.2 vs 0 mg/day).

Factors associated with decreased opioid consumption following VCF surgery included time to surgery, in which those who had surgery any time ≥8 days after diagnosis were associated with increased odds of discontinuation (odds ratio [OR] range, 1.59-1.86; all P <.0001). Other predictors were baseline diagnosis of osteoporosis (OR, 1.37; 95% CI, 1.23-1.53; P <.0001), baseline muscle relaxant prescription (OR, 1.26; 95% CI, 1.13-1.41; P <.0001), and age ≥65 years (OR, 1.15; 95% CI, 1.01-1.31; P =.0364).

Factors which associated with lower odds of discontinuing use included Charlson Score Group ≥2 (OR, 0.82; 95% CI, 0.73-0.91; P =.0025) and Charlson Score Group 1 (OR, 0.8; 95% CI, 0.71-0.91; P =.0005).

Patients who decreased or discontinued opioid use associated with -$6,759 adjusted all-cause payer costs and those who maintained, increased, or had a new opioid prescription, $160 (P <.001).

This study may have been limited by not directly evaluating opioid consumption.

Most patients with VCF who underwent BKP or VP were able to decrease or discontinue opioid consumption. Additional study is needed to compare surgical interventions with conservative medical management.

“The benefits of minimizing opioid use in the elderly, and the economic benefit of reducing all-cause payer costs, our findings add to the  argument favoring vertebral augmentation over [conservation] medical management” as a treatment strategy to address VCF,” the study authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Ni W, Ricker C, Quinn M, et al. Trends in opioid use following balloon kyphoplasty or vertebroplasty for the treatment of vertebral compression fractures.Osteoporos Int. Published online Novmeber 2, 2021. doi:10.1007/s00198-021-06163-3