Sex Differences in Opioid Prescriptions Following Anterior Cervical Spine Surgery

Study Design: Retrospective cohort study. Objective: Our objective was to compare postoperative opioid prescriptions between male and female patients after anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). Summary of background data: Sex differences in pain are well-established in basic science and clinical medicine; however, sex differences in postoperative pain management after spine surgery are less well-studied. Methods: The Marketscan Commercial Claims and Encounters database was queried for adults without a history of chronic opioid use who underwent ACDF or CDA from January 2017 through June 2021. Binary logistic regression analyses of filling an opioid prescription and generalized linear model analyses of total oral morphine milligram equivalents (MMEs) prescribed were performed. “Perioperative” prescription were defined as 30 days before to 14 days after surgery; “prolonged postoperative” was defined as 91 to 180 days after surgery. Results: For single-level ACDF (n=9844; 51.7% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.36; 95% CI: 1.18, 1.56; P <0.001] and filled lower perioperative MMEs than males [adjusted mean difference (AMD): −15.32; 95% CI: −28.52, −2.13; P =0.02]. For multilevel ACDF (n=12,871; 52.5% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.16; 95% CI: 1.03, 1.30; P =0.02] and filled lower MMEs than males in the perioperative period [AMD: −27.47; 95% CI: −39.78, −15.17; P <0.001]. After CDA (n=3283, 48.8% female), females were more likely to fill a prolonged postoperative opioid prescription [aOR: 1.53; 95% CI: 1.17, 2.00; P =0.002], but there was no association between sex and perioperative or prolonged postoperative MME. Conclusions: These findings can guide the expectations on postoperative opioid prescribing after ACDF/CDA and warrant further studies to confirm the results and optimize postoperative pain management. Level of Evidence: Level III.