TY - JOUR
T1 - Opioids and spinal cord stimulators
T2 - Pre-and postoperative opioid use patterns and predictors of prolonged postoperative opioid use
AU - Labaran, Lawal
AU - Aryee, Jomar N.A.
AU - Bell, Joshua
AU - Jain, Nikhil
AU - Puvanesarajah, Varun
AU - Raad, Michael
AU - Jain, Amit
AU - Carmouche, Jonathan
AU - Hassanzadeh, Hamid
N1 - Publisher Copyright:
© 2020 by the Korean Spinal Neurosurgery Society.
PY - 2020/3
Y1 - 2020/3
N2 - Objective: The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. Methods: A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3-and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magni-tudes of preoperative opioid use. Results: A total of 2,374 patients who underwent SCS placement were identified. Of all pa-tients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. Conclusion: Patients with greater number of preoperative opioid prescriptions may not at-tain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.
AB - Objective: The aim of the study was to compare trends and differences in preoperative and prolonged postoperative opioid use following spinal cord stimulator (SCS) implantation and to determine factors associated with prolonged postoperative opioid use. Methods: A database of private-payer insurance records was queried to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-C3655) from 2008–2015. Our resulting cohort was stratified into those with prolonged postoperative opioid use, opioid use between 3-and 6-month postoperation, and those without. Multivariate logistic regression was used to determine the effect preoperative opioid use and other factors of interest had on prolonged postoperative opioid use. Subgroup analysis was performed on preoperative opioid users to further quantify the effect of differing magni-tudes of preoperative opioid use. Results: A total of 2,374 patients who underwent SCS placement were identified. Of all pa-tients, 1,890 patients (79.6%) were identified as having prolonged narcotic use. Annual rates of preoperative (p = 0.023) and prolonged postoperative narcotic use (p < 0.001) decreased over the study period. Significant independent predictors of prolonged postoperative opioid use were age < 65 years (odds ratio [OR], 1.52; p = 0.004), male sex (OR, 1.33; p = 0.037), preoperative anxiolytic (OR, 1.55; p = 0.004) and muscle relaxant (OR, 1.42; p = 0.033), and narcotic use (OR, 15.04; p < 0.001). Increased number of preoperative narcotic prescriptions correlated with increased odds of prolonged postoperative use. Conclusion: Patients with greater number of preoperative opioid prescriptions may not at-tain the same benefit from SCSs as patients with less opioid use. The most significant predictor of prolonged narcotic use was preoperative opioid use.
KW - Chronic pain
KW - Narcotics
KW - Opioids
KW - Spinal cord stimulator
KW - Spine surgery
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U2 - 10.14245/ns.1938308.154
DO - 10.14245/ns.1938308.154
M3 - Article
C2 - 32252174
AN - SCOPUS:85083056817
SN - 2586-6583
VL - 17
SP - 246
EP - 253
JO - Neurospine
JF - Neurospine
IS - 1
ER -