Take-Home Naloxone for the Prevention of Adverse Outcomes due to Opioid Overuse in Inpatient Neurosurgical Patients: A Multi-Center Retrospective Cohort Analysis

Introduction: Increased operational costs and overdose rates make opioid stewardship important to monitor in post-surgical patients. Naloxone has been a method to symptomatically reverse drug overdoses. By providing patients with a co-prescription of naloxone and opioids, healthcare departments have attempted to reduce adverse outcomes due to opioid overuse. Take-home naloxone’s efficacy in opioid overdose prevention programs has not been thoroughly studied within the general practice of neurosurgery.

Methods: Patients who had undergone neurosurgical procedures including laminectomy, carotid endarterectomy, craniotomy, cerebrovascular shunts, and spinal fusions and prescribed opioids: tramadol, hydrocodone, and oxycodone were identified in TrinetX, a global health records database. Inpatient neurosurgical patients were identified within the database via ICD-10 procedure code mappings as detailed by the National Healthcare Safety Network within the Centers for Disease Control. The patients were stratified based on whether they did or did not receive naloxone. Outcomes death and overdose were compared between the stratified groups via odds ratios and Kaplan-Meier Survival Analysis.

Results: The cohort is comprised of 758,725 patients divided into 257,802 who received naloxone and 500,923 who did not.
For spinal fusions and laminectomies that received naloxone post-operatively, odds of death were reduced by factors of 0.636 and 0.627, respectively. Overdose odds in carotid endarterectomies were reduced by a factor of 0.551. Overdose odds in cerebrovascular shunts were increased by a factor of 1.516.
Kaplan-Meier Survival Analyses revealed that naloxone co-prescription decreased overdose rates by 1.36% in carotid endarterectomies, but increased overdose rates by 0.97% in cerebrovascular shunts and by 0.26% in craniotomies (p < 0.05). Naloxone co-prescription decreased outcomes of death in spinal fusions by 0.89%, and laminectomies by 1.1%, but increased outcomes of death in craniotomies by 0.4% (p < 0.05).

Conclusion : Take-home naloxone is effective at reducing death or overdose in carotid endarterectomies, spinal fusions, and laminectomies, but harmful for craniotomies and cerebrovascular shunts.