Association Between Spine Surgery and Availability of Opioid Medication

Warner, Nafisseh S.; Habermann, Elizabeth B.; Hooten, W. Michael; Hanson, Andrew C.; Schroeder, Darrell R.; Sauver, Jennifer L. St.; Huddleston, P.M.; Bydon, Mohamad; Cunningham, Julie L.; Gazelka, Halena M.; Warner, David O.

doi:10.1001/jamanetworkopen.2020.8974

Cited by 17 publications

(20 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors undertook a population-based cohort study 3 of 2223 adults who were integrated in the Rochester Epidemiology Project, which links health care records across health care institutions in southeastern Minnesota. This allowed the study team to obtain detailed opioid prescription data, which was critical to define their outcomes of interest.…”

mentioning

confidence: 99%

“…One key question that needs to be addressed is the external validity of the study by Warner et al 3 The study cohort was nested within the Rochester Epidemiology Project with accurate prescription data available for the study, which may not be available in other hospitals and health systems. However, prescription drug monitoring programs provide promising state-level data that can be used to closely monitor prescription medication use before and after operations.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Redefining Opioid Use Patterns After Surgical Procedures: Why a New Paradigm Is Critical

Naik

2020

JAMA Netw Open

View full text Add to dashboard Cite

The risk of developing an opioid use disorder after an elective operation is increasingly recognized. 1 Within the surgical population, patients undergoing major spine operations represent a high-risk cohort: approximately 20% to 70% of patients use opioids prior to operations, preoperative patientreported pain scores are high, and 50% to 60% of patients have undergone a previous spine procedure. 2 The study by Warner et al 3 addresses an important gap in knowledge regarding patterns of opioid use after major spine operations.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Redefining Opioid Use Patterns After Surgical Procedures: Why a New Paradigm Is Critical

Naik

2020

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…These were subsequently converted to oral morphine milligram equivalents (OME) utilizing the Centers for Disease Control and Prevention opioid calculation tool 17 to quantify cumulative opioid consumption, consistent with previous research. 18,19 As medications contained in the IDDS at the time of presentation to surgery were not available through the Acute Care Datamart, manual chart review was conducted to abstract data on total duration of IDDS therapy before surgery and IDDS device settings (ie, opioid type, total opioid dose delivered, nonopioid additives, infusion delivery settings).…”

Section: Data Collectionmentioning

confidence: 99%

Perioperative Opioid Consumption and Clinical Outcomes in Surgical Patients With a Pre-existing Opioid-Based Intrathecal Drug Delivery System

D’Souza¹,

Warner²,

Olatoye³

et al. 2021

Anesthesia &Amp; Analgesia

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Intrathecal drug delivery systems (IDDS) have been utilized for over 3 decades for management of chronic pain and spasticity. Patients with IDDS may present for surgical procedures unrelated to the IDDS device, although data are limited regarding perioperative outcomes. METHODS: This is a historical matched cohort study conducted between January 1, 2007 and December 31, 2016 of patients with an opioid-based IDDS versus matched control patients undergoing surgery excluding interventional pain procedures. Patients in the IDDS group were matched with up to 2 patients without an IDDS. Multivariable regression analyses were utilized to assess differences in the primary outcome of cumulative perioperative opioid consumption (ie, intraoperative and postanesthesia care unit [PACU] opioid consumption), and opioid consumption during the first 24 and 72 postoperative hours. Postoperative clinical outcomes were also assessed including escalating oxygen requirements, naloxone administration, painsedation mismatch, and perioperative pain service consultation. RESULTS: A total of 321 surgeries were included, 112 with IDDS and 209 controls, with median (interquartile range [IQR]) age of 57 (49-64) years. Compared to matched controls, patients with an IDDS had greater perioperative opioid consumption (median [IQR] oral morphine milligram equivalents [OME] of 110 vs 93 [IQR,; adjusted multiplicative increase 1.28 [95% confidence interval {CI}, 1.03-1.59]; P = .026). IDDS patients also had greater opioid consumption in the first 24 and 72 postoperative hours (multiplicative increases of 2.23 [95% CI, 1.36-3.63], P = .001, and 2.46 [95% CI, 1.41-4.32], P = .002, respectively). There were no significant differences in postoperative oxygen requirements, naloxone administration, or pain-sedation mismatch. Inpatient pain medicine consultation was more frequent in IDDS patients compared to controls (51.8% vs 6.2%; P < .001). CONCLUSIONS: Patients with opioid-based IDDS received more perioperative opioids and were more likely to receive postoperative pain service consultation compared to matched controls. There were no significant differences in clinical safety outcomes, suggesting tolerance for higher opioid doses. Further research is warranted to optimize perioperative outcomes in those with IDDS. (Anesth Analg 2022;134:35-43) KEY POINTS• Question: How do perioperative outcomes of opioid consumption and postoperative respiratory complications compare between patients with an opioid-based intrathecal drug delivery system (IDDS) versus control patients without an IDDS? • Findings: Patients with an opioid-based IDDS consumed more perioperative opioids, yet experienced similar adverse events (ie, escalation in postoperative oxygen requirements, postoperative naloxone administration, and pain-sedation mismatch) compared to matched control patients. • Meaning: Patients with an opioid-based IDDS have greater perioperative opioid needs with no differences in safety outcomes, suggesting tolerance for higher opioid doses.

show abstract

“…For patients on prescription opioids a related aim is to reduce or eliminate opioid use. The risk of lasting or new-onset persistent opioid use after spine surgery is increasingly recognized, 6 and previous studies have described wide variations in long-term prevalence of prescription opioid use after spinal surgery with rates varying from 26% to 52% 2,7–9 . Further, studies show a high prevalence of come-dication with benzodiazepines and benzodiazepine-related hypnotics (z-hypnotics) in patients with persistent opioid use for chronic non-malignant pain 5,10,11 .…”

mentioning

confidence: 99%

Persistent Use of Prescription Opioids Following Lumbar Spine Surgery

Holmberg

Fredheim

Salvesen

et al. 2021

Spine

View full text Add to dashboard Cite

Study Design. Prospective pharmacoepidemiological study. Objective. To investigate the use of prescription opioids 2 years following degenerative lumbar spine surgery. Summary of Background Data. There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use following some of the most common surgical procedures are lacking. Methods. Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disability was measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017. Results. Among 32,886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery.Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (odds ratio [OR] 31.10, 95% confidence interval [CI] 26.9-36.0, P ¼ 0.001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P ¼ 0.001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P ¼ 0.001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at 1 year was observed in persistent opioid users compared with non-persistent users (41.5 vs. 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at 1 year compared with non-persistent users (37.7% vs. 52.6%, P ¼ 0.001). Conclusion.Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.

show abstract

Association Between Spine Surgery and Availability of Opioid Medication

Cited by 17 publications

References 26 publications

Redefining Opioid Use Patterns After Surgical Procedures: Why a New Paradigm Is Critical

Redefining Opioid Use Patterns After Surgical Procedures: Why a New Paradigm Is Critical

Perioperative Opioid Consumption and Clinical Outcomes in Surgical Patients With a Pre-existing Opioid-Based Intrathecal Drug Delivery System

Persistent Use of Prescription Opioids Following Lumbar Spine Surgery

Contact Info

Product

Resources

About