TY - JOUR
T1 - The Association of Preoperative Opioid Usage with Patient-Reported Outcomes, Adverse Events, and Return to Work after Lumbar Fusion
T2 - Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC)
AU - Zakaria, Hesham Mostafa
AU - Mansour, Tarek R.
AU - Telemi, Edvin
AU - Asmaro, Karam
AU - Bazydlo, Michael
AU - Schultz, Lonni
AU - Nerenz, David R.
AU - Abdulhak, Muwaffak
AU - Khalil, Jad G.
AU - Easton, Richard
AU - Schwalb, Jason M.
AU - Park, Paul
AU - Chang, Victor
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - BACKGROUND: It is important to delineate the relationship between opioid use and spine surgery outcomes. OBJECTIVE: To determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry. METHODS: Preoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (<6 wk), short-Term users (6 wk-3 mo), intermediate-Term users (3-6 mo), and chronic users (>6 mo). Multivariate generalized estimating equation models were constructed. RESULTS: All comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P =. 001), 1 yr (RR 0.89, P =. 001), and 2 yr (RR 0.89, P =. 005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P <. 001), 1 yr (RR 1.17, P <. 001), and 2 yr (RR 1.19, P =. 002). Short-Term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P <. 001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P =. 004), 1 yr (RR 0.85, P <. 001), and 2 yr (RR 0.80, P =. 003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P <. 001). CONCLUSION: In lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.
AB - BACKGROUND: It is important to delineate the relationship between opioid use and spine surgery outcomes. OBJECTIVE: To determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry. METHODS: Preoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (<6 wk), short-Term users (6 wk-3 mo), intermediate-Term users (3-6 mo), and chronic users (>6 mo). Multivariate generalized estimating equation models were constructed. RESULTS: All comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P =. 001), 1 yr (RR 0.89, P =. 001), and 2 yr (RR 0.89, P =. 005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P <. 001), 1 yr (RR 1.17, P <. 001), and 2 yr (RR 1.19, P =. 002). Short-Term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P <. 001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P =. 004), 1 yr (RR 0.85, P <. 001), and 2 yr (RR 0.80, P =. 003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P <. 001). CONCLUSION: In lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.
KW - Morbidity
KW - Opioid-related disorders
KW - Patient satisfaction
KW - Patient-reported outcome measures
KW - Quality improvement
KW - Spinal fusion
KW - Spine surgery
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U2 - 10.1093/neuros/nyz423
DO - 10.1093/neuros/nyz423
M3 - Article
C2 - 31595963
AN - SCOPUS:85082854238
SN - 0148-396X
VL - 87
SP - 142
EP - 149
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -