Alexandra Stratton1, Eugene Wai1, Stephen Kingwell1, Philippe Phan1, Darren Roffey1, Mohamed El Koussy1, Sean Christie1, Peter Jarzem1, Parham Rasoulinejad1, Steve Casha1, Jerome Paquet1, Michael Johnson1, Edward Abraham1, Hamilton Hall1, Greg McIntosh1, Kenneth Thomas1, Raja Rampersaud1, Neil Manson1, Charles Fisher1. 1. From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher).
Abstract
Background: Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1-year postoperative opioid use. Methods: A retrospective analysis was performed on prospectively collected data from the Canadian Spine Outcomes and Research Network for patients undergoing elective thoracic and lumbar surgery. Self-reported opioid use at baseline, before surgery and at 1 year after surgery was compared. Baseline opioid use was compared by age, sex, radiologic diagnosis and presenting complaint. All patients meeting eligibility criteria from 2008 to 2017 were included. Results: A total of 3134 patients provided baseline opioid use data. No significant change in the proportion of patients taking daily (range 32.3%-38.2%) or intermittent (range 13.7%-22.5%) opioids was found from pre-2014 to 2017. Among patients who waited more than 6 weeks for surgery, the frequency of opioid use did not differ significantly between the baseline and preoperative time points. Significantly more patients using opioids had a chief complaint of back pain or radiculopathy than neurogenic claudication (p < 0.001), and significantly more were under 65 years of age than aged 65 years or older (p < 0.001). Approximately 41% of patients on daily opioids at baseline remained so at 1 year after surgery. Conclusion: These data suggest that additional opioid reduction strategies are needed in the population of patients undergoing elective thoracic and lumbar spine surgery. Spine surgeons can be involved in identifying patients taking opioids preoperatively, emphasizing the risks of continued opioid use and referring patients to appropriate evidence-based treatment programs.
Background: Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1-year postoperative opioid use. Methods: A retrospective analysis was performed on prospectively collected data from the Canadian Spine Outcomes and Research Network for patients undergoing elective thoracic and lumbar surgery. Self-reported opioid use at baseline, before surgery and at 1 year after surgery was compared. Baseline opioid use was compared by age, sex, radiologic diagnosis and presenting complaint. All patients meeting eligibility criteria from 2008 to 2017 were included. Results: A total of 3134 patients provided baseline opioid use data. No significant change in the proportion of patients taking daily (range 32.3%-38.2%) or intermittent (range 13.7%-22.5%) opioids was found from pre-2014 to 2017. Among patients who waited more than 6 weeks for surgery, the frequency of opioid use did not differ significantly between the baseline and preoperative time points. Significantly more patients using opioids had a chief complaint of back pain or radiculopathy than neurogenic claudication (p < 0.001), and significantly more were under 65 years of age than aged 65 years or older (p < 0.001). Approximately 41% of patients on daily opioids at baseline remained so at 1 year after surgery. Conclusion: These data suggest that additional opioid reduction strategies are needed in the population of patients undergoing elective thoracic and lumbar spine surgery. Spine surgeons can be involved in identifying patients taking opioids preoperatively, emphasizing the risks of continued opioid use and referring patients to appropriate evidence-based treatment programs.
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