Rabia Qureshi1, Brian Werner1, Varun Puvanesarajah2, Jason A Horowitz1, Amit Jain3, Daniel Sciubba4, Francis Shen1, Hamid Hassanzadeh5. 1. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. 2. Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. 3. Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA. 4. Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA. 5. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: HH4XD@hscmail.mcc.virginia.edu.
Abstract
BACKGROUND: Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. METHODS: The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. RESULTS: Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9). CONCLUSIONS: Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period.
BACKGROUND: Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. METHODS: The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. RESULTS: Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9). CONCLUSIONS:Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period.
Authors: Ruchir N Karmali; Christopher Bush; Sudha R Raman; Cynthia I Campbell; Asheley C Skinner; Andrew W Roberts Journal: Pharmacoepidemiol Drug Saf Date: 2019-12-18 Impact factor: 2.890
Authors: Yoji Ogura; Jeffrey L Gum; Portia Steele; Charles H Crawford; Mladen Djurasovic; R Kirk Owens; Joseph Laratta; Morgan Brown; Christy Daniels; John R Dimar; Steven D Glassman; Leah Y Carreon Journal: J Spine Surg Date: 2021-03
Authors: Frank M Mezzacappa; Kyle P Schmidt; Steven O Tenny; Kaeli K Samson; Sandeep K Agrawal; Leslie C Hellbusch Journal: Medicine (Baltimore) Date: 2020-11-20 Impact factor: 1.817