Journal
SPINE
Volume 44, Issue 12, Pages 887-895Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BRS.0000000000002964
Keywords
complications; disability; function; narcotics; opioid dosage; opioids; outcomes; patient-reported outcomes; postoperative opioid use; preoperative chronic; preoperative opioid; satisfaction; spinal fusion; spine surgery
Categories
Funding
- NIH/NCATS Colorado CTSA [UL1 TR001082]
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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 1year 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 [1.42.2]), 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 90day complications, regardless of dosage. Both preoperative chronic opioid therapy and high-preoperative dosage are independently associated with postoperative chronic opioid use.
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