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. 2019 Jun 15;44(12):887-895.
doi: 10.1097/BRS.0000000000002964.

Preoperative Opioids and 1-year Patient-reported Outcomes After Spine Surgery

Jeffrey M Hills  1 , Jacquelyn S Pennings  1 , Kristin R Archer  1   2 , Joseph B Wick  3 , Joshua Daryoush  4 , Marjorie Butler  4 , Ahilan Sivaganesan  5 , Inamullah Khan  1 , Richard Call  1   5 , Clinton J Devin  1   5   6
Affiliations

Preoperative Opioids and 1-year Patient-reported Outcomes After Spine Surgery

Jeffrey M Hills et al. Spine (Phila Pa 1976). .

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.

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References

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    1. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS)], Fourth edition, forthcoming. Available at: http://www.boneandjointburden.org. Accessed July 15, 2018.
    1. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162:276–286.
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    1. Reuben DB, Alvanzo AA, Ashikaga T, et al. National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain. Ann Intern Med 2015; 162:295–300.

MeSH terms

Substances