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. 2024 Jul;14(6):1738-1744.
doi: 10.1177/21925682231154854. Epub 2023 Jan 25.

Association Between Early Surgery and Postoperative Opioid Use in Patients With Lumbar Disc Herniation: A Propensity Score-Matching Analysis Using an Administrative Claims Database in Japan

Akira Honda  1 , Yoichi Iizuka  1 , Mieda Tokue  1 , Eiji Takasawa  1 , Sho Ishiwata  1 , Yusuke Tomomatsu  1 , Shunsuke Ito  1 , Kazuhiro Inomata  1 , Akira Okada  2 , Hiroki Matsui  3 , Hideo Yasunaga  3 , Hirotaka Chikuda  1
Affiliations

Association Between Early Surgery and Postoperative Opioid Use in Patients With Lumbar Disc Herniation: A Propensity Score-Matching Analysis Using an Administrative Claims Database in Japan

Akira Honda et al. Global Spine J. 2024 Jul.

Abstract

Study design: Retrospective cohort study.

Objectives: This study aimed to investigate whether early surgery shortens the duration of opioid use in patients who underwent surgery with lumbar disc herniation.

Methods: We extracted patients who underwent surgery at least 2 weeks after they were diagnosed with lumbar disc herniation between April 2014 and May 2021. Opioid use after surgery was compared between patients who underwent surgery within 90 days (early surgery group) and 90 days or later (late surgery group). Propensity-score-matching analysis and multivariable Cox hazard regression analysis with a restricted cubic spline model were conducted to evaluate the association between the timing of surgery and termination of opioid use after surgery.

Results: A total of 1597 eligible patients were identified, with 807 (51%) in the early surgery group. In the propensity-score-matched cohort, the early surgery group had a significantly lower proportion of opioid use than the control group (28% vs 48%, percent difference -20%, P < .001). Multivariable Cox hazard regression analysis showed that early surgery was significantly associated with the earlier termination of opioid use (HR, 3.13; 95% CI, 1.97-4.97; P < .001). Restricted cubic spline model showed a monotonically decreased hazard ratio and decreased hazard ratio of .50 in patients who underwent surgery 111 days or later after the diagnosis.

Conclusions: Early surgery, especially within 90 days, was associated with earlier opioid use termination after surgery. Regarding the duration of opioid use following surgery, surgical treatment may be preferable to perform within around 4 months after the diagnosis.

Keywords: analgesic; early surgery; lumbar disc herniation; opioid use termination; postoperative pain; timing of surgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of patient selection.
Figure 2.
Figure 2.
Kaplan–Meier curves of opioid use termination following surgery between the early and late surgery groups during the observational period.
Figure 3.
Figure 3.
Restricted cubic spline curb showing the association between the time of surgery and opioid use termination following surgery.
See this image and copyright information in PMC

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