Sex Differences in Opioid Prescriptions Following Anterior Cervical Discectomy and Fusion

Introduction: Sex differences in pain are well-established in basic science and clinical medicine; however, sex differences in postoperative pain management following anterior cervical discectomy and fusion (ACDF) are less well-studied. Our objective was to compare postoperative opioid prescriptions between male and female patients following ACDF.

Methods: The Marketscan Commercial Claims and Encounters database was queried for adults without a history of chronic opioid use who underwent ACDF from January 2017 through June 2021. “Perioperative” was defined as 30 days before to 14 days after surgery; “prolonged” was defined as 15 to 180 days after surgery. Binary logistic regression analyses of opioid prescriptions filled and generalized linear model analyses of total oral morphine milligram equivalents (MMEs) prescribed were performed, with alpha =0.05.

Results: For single-level ACDF (n=9844; 51.7% female), there was no association between sex and perioperative prescriptions filled [odds ratio (OR): 1.11; 95% confidence interval (CI): 0.99, 1.24; p=0.09]. Females were more likely to fill a prolonged postoperative prescription [OR: 1.22; 95% CI: 1.10, 1.36; p< 0.001]. Females used lower perioperative MMEs than males [adjusted mean difference (AMD): -14.23; 95% CI: -27.55, -0.91; p=0.04] but not prolonged postoperative MMEs [AMD: -34.63; 95% CI: -83.58, 14.32; p=0.17].

For multi-level ACDF (n=12,871; 52.5% female), there were no sex-related differences in perioperative [OR: 0.94; 95% CI: 0.85, 1.04; p=0.20] or prolonged postoperative prescriptions [OR: 1.09; 95% CI: 0.997, 1.19; p=0.06] filled. However, females filled lower MMEs than males in both the perioperative [AMD: -26.54; 95% CI: -38.91, -14.18; p< 0.001] and prolonged postoperative periods [AMD: -60.94; 95% CI: -103.82, -18.05; p=0.005].

Conclusion : Female patients undergoing single-level ACDF were more likely to fill an opioid prescription 15-180 days postoperatively but used lower perioperative MMEs than males. In multi-level ACDF, females used lower MMEs in the perioperative and prolonged postoperative periods. These findings can guide postoperative opioid prescribing after ACDF and warrant further studies to confirm the results and optimize postoperative pain management.