Jeffrey M Hills1, Jacquelyn S Pennings1, Kristin R Archer1,2, Joseph B Wick3, Joshua Daryoush4, Marjorie Butler4, Ahilan Sivaganesan5, Inamullah Khan1, Richard Call1,5, Clinton J Devin1,5,6. 1. Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN. 2. Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Orthopaedic Surgery, UC Davis, Sacramento, CA. 4. Vanderbilt University School of Medicine, Nashville, TN. 5. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN. 6. Orthopaedics of Steamboat Springs, Steamboat Springs, CO.
Abstract
STUDY DESIGN: Longitudinal Cohort Study. OBJECTIVE: Determine 1-year patient-reported outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosages in patients undergoing elective spine surgery. SUMMARY OF BACKGROUND DATA: Back pain is the most disabling condition worldwide and over half of patients presenting for spine surgery report using opioids. Preoperative dosage has been correlated with poor outcomes, but published studies have not assessed the relationship of both preoperative chronic opioids and opioid dosage with patient-reported outcomes. METHODS: For patients undergoing elective spine surgery between 2010 and 2017, our prospective institutional spine registry data was linked to opioid prescription data collected from our state's Prescription Drug Monitoring Program to analyze outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosage, while adjusting for confounders through multivariable regression analyses. Outcomes included 1-year meaningful improvements in pain, function, and quality of life. Additional outcomes included 1-year satisfaction, return to work, 90-day complications, and postoperative chronic opioid use. RESULTS: Of 2128 patients included, preoperative chronic opioid therapy was identified in 21% and was associated with significantly higher odds (adjusted odds ratio [95% confidence interval]) of not achieving meaningful improvements at 1-year in extremity pain (aOR:1.5 [1.2-2]), axial pain (aOR:1.7 [1.4-2.2]), function (aOR:1.7 [1.4-2.2]), and quality of life (aOR:1.4 [1.2-1.9]); dissatisfaction (aOR:1.7 [1.3-2.2]); 90-day complications (aOR:2.9 [1.7-4.9]); and postoperative chronic opioid use (aOR:15 [11.4-19.7]). High-preoperative opioid dosage was only associated with postoperative chronic opioid use (aOR:4.9 [3-7.9]). CONCLUSION: Patients treated with chronic opioids prior to spine surgery are significantly less likely to achieve meaningful improvements at 1-year in pain, function, and quality of life; and less likely to be satisfied at 1-year with higher odds of 90-day complications, regardless of dosage. Both preoperative chronic opioid therapy and high-preoperative dosage are independently associated with postoperative chronic opioid use. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: Longitudinal Cohort Study. OBJECTIVE: Determine 1-year patient-reported outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosages in patients undergoing elective spine surgery. SUMMARY OF BACKGROUND DATA: Back pain is the most disabling condition worldwide and over half of patients presenting for spine surgery report using opioids. Preoperative dosage has been correlated with poor outcomes, but published studies have not assessed the relationship of both preoperative chronic opioids and opioid dosage with patient-reported outcomes. METHODS: For patients undergoing elective spine surgery between 2010 and 2017, our prospective institutional spine registry data was linked to opioid prescription data collected from our state's Prescription Drug Monitoring Program to analyze outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosage, while adjusting for confounders through multivariable regression analyses. Outcomes included 1-year meaningful improvements in pain, function, and quality of life. Additional outcomes included 1-year satisfaction, return to work, 90-day complications, and postoperative chronic opioid use. RESULTS: Of 2128 patients included, preoperative chronic opioid therapy was identified in 21% and was associated with significantly higher odds (adjusted odds ratio [95% confidence interval]) of not achieving meaningful improvements at 1-year in extremity pain (aOR:1.5 [1.2-2]), axial pain (aOR:1.7 [1.4-2.2]), function (aOR:1.7 [1.4-2.2]), and quality of life (aOR:1.4 [1.2-1.9]); dissatisfaction (aOR:1.7 [1.3-2.2]); 90-day complications (aOR:2.9 [1.7-4.9]); and postoperative chronic opioid use (aOR:15 [11.4-19.7]). High-preoperative opioid dosage was only associated with postoperative chronic opioid use (aOR:4.9 [3-7.9]). CONCLUSION:Patients treated with chronic opioids prior to spine surgery are significantly less likely to achieve meaningful improvements at 1-year in pain, function, and quality of life; and less likely to be satisfied at 1-year with higher odds of 90-day complications, regardless of dosage. Both preoperative chronic opioid therapy and high-preoperative dosage are independently associated with postoperative chronic opioid use. LEVEL OF EVIDENCE: 2.
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: Andre M Samuel; Kyle W Morse; Yuri A Pompeu; Avani S Vaishnav; Catherine Himo Gang; Han Jo Kim; Sheeraz A Qureshi Journal: Spine Deform Date: 2022-01-22
Authors: Anna E Wentz; Ralph C Wang; Brandon D L Marshall; Theresa I Shireman; Tao Liu; Roland C Merchant Journal: J Emerg Med Date: 2021-10-21 Impact factor: 1.473
Authors: Nafisseh S Warner; Elizabeth B Habermann; W Michael Hooten; Andrew C Hanson; Darrell R Schroeder; Jennifer L St Sauver; Paul M Huddleston; Mohamad Bydon; Julie L Cunningham; Halena M Gazelka; David O Warner Journal: JAMA Netw Open Date: 2020-06-01
Authors: Breton Line; Shay Bess; Jeffrey L Gum; Richard Hostin; Khaled Kebaish; Christopher Ames; Douglas Burton; Gregory Mundis; Robert Eastlack; Munish Gupta; Eric Klineberg; Virgine Lafage; Renaud Lafage; Frank Schwab; Christopher Shaffrey; Justin S Smith Journal: N Am Spine Soc J Date: 2021-12-12
Authors: Ruiqi Tang; Katherine B Santosa; Joceline V Vu; Lewei A Lin; Yen-Ling Lai; Michael J Englesbe; Chad M Brummett; Jennifer F Waljee Journal: Ann Surg Date: 2022-01-01 Impact factor: 12.969