Baseline Risk Factors for Prolonged Opioid Use Following Spine Surgery: Systematic Review and Meta-Analysis

Abstract

Objective: To conduct a comprehensive systematic review and meta-analysis of current retrospective cohort studies to identify significant preoperative risk factors for prolonged postoperative opioid use following spine surgery.

Methods: Studies were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses through a search of PubMed, Google Scholar, Scopus, and Cochrane databases. Unique articles were screened by 2 independent reviewers. Primary research articles reporting odds ratios of risk factors for prolonged opioid use following spine surgery were included. Prolonged opioid use was defined as continued use ≥3 months following surgery, and study quality was evaluated using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to calculate pooled odds ratios and confidence intervals.

Results: The initial search yielded 648 studies. Following duplicate removal, 492 titles and abstracts were screened. After full-text review of 68 studies, 19 final studies including 168,961 patients were eligible for meta-analysis. Newcastle-Ottawa Scale scores ranged from 6 to 9. Meta-analysis assessed 17 risk factors for long-term opioid use. Preoperative opioid use, depression, depression and/or anxiety, drug abuse or dependency, female gender, fibromyalgia, lower back pain, tobacco use, and chronic pulmonary disease were found to be statistically significant risk factors for prolonged opioid use.

Conclusions: Several patient-level factors may play a role in the tendency to persistently use opioids after spine surgery. By preoperatively identifying these characteristics, clinicians may be better able to identify patients who are at risk and employ methods to mitigate potential long-term opioid use.

Keywords: Narcotics; Opioid abuse; Opioid dependency; Prolonged opioid use; Risk factors; Spine surgery.