Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients

Rabia Qureshi, Brian Werner, Varun Puvanesarajah, Jason A. Horowitz, Amit Jain, Daniel Sciubba, Francis Shen, Hamid Hassanzadeh

Research output: Contribution to journalArticle

Abstract

Background: Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. Methods: The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. Results: Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9). Conclusions: Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Diskectomy
Narcotics
Prescriptions
Odds Ratio
Drug Prescriptions
Pain Management
Opioid-Related Disorders
Migraine Disorders
Postoperative Period
Opioid Analgesics
Comorbidity
Diabetes Mellitus

Keywords

  • Discectomy
  • Narcotics
  • Pain management
  • Postoperative pain
  • Risk factors

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients. / Qureshi, Rabia; Werner, Brian; Puvanesarajah, Varun; Horowitz, Jason A.; Jain, Amit; Sciubba, Daniel; Shen, Francis; Hassanzadeh, Hamid.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Qureshi, Rabia ; Werner, Brian ; Puvanesarajah, Varun ; Horowitz, Jason A. ; Jain, Amit ; Sciubba, Daniel ; Shen, Francis ; Hassanzadeh, Hamid. / Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients. In: World Neurosurgery. 2018.
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abstract = "Background: Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. Methods: The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. Results: Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9). Conclusions: Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period.",
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