Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The authors set out to conduct the first national-level study assessing the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013–2014 National (Nationwide) Inpatient Sample database. Multivariable logistic regression was implemented to analyze how OUD status impacted in-hospital complications, length of hospital stay, discharge disposition, and total charges by procedure type.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 139,995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%, p &lt; 0.0001). OUD patients had higher odds of pulmonary (p = 0.0006), infectious (p &lt; 0.0001), and hematological (p = 0.0009) complications. Multivariate regression modeling of outcomes by procedure type showed that after ALIF, OUD patients had higher odds of nonhome discharge (p = 0.0007), extended hospitalization (p = 0.0002), and greater total charges (p = 0.0054). This analysis also revealed that OUD patients faced higher odds of complication (p = 0.0149 and p = 0.0471), extended hospitalization (p = 0.0439 and p = 0.0001), and higher total charges (p &lt; 0.0001 and p &lt; 0.0001) after PLIF and LLIF procedures, respectively.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Obtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step toward developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize the outcome profiles for lumbar fusion procedures in OUD patients on a national level, found that this population tended to experience increased odds of complications, extended hospitalization, nonhome discharge, and higher total costs. Results from this study warrant future prospective studies to better the understanding of these associations and to further the development of better ERAS programs that may improve patient care and reduce cost burden.</jats:p></jats:sec>

The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty

“…A similar analysis conducted on pregnant women demonstrated similar findings with significantly increased rates of opioid use disorders over time [22]. e incidence of OUDs in patients undergoing lumbar fusion was found to be 0.91%, which is higher than our identified rate of 0.36% in 2015 [23]. is is also lower than the rate that was found in a similar study performed on patients undergoing lower extremity bypass (0.63%) [24] and lower than the 0.81% that has been reported for the general population [24,25].…”

“…ough novel, our finding that patients with OUD sustain high postoperative morbidity is consistent with prior literature. Similar analyses conducted on patients undergoing lumbar fusion [23] and lower extremity bypass [24] procedures demonstrated similar results, findings that Advances in Orthopedics patients with OUDs had higher rates of complications and nonhome discharge, as well as increased length of stay and total charges. Additionally, patients who are prescribed preoperative opioids before undergoing a THA or TKA are known to be at higher risk for postoperative complications and increased postoperative opioid consumption [4-7, 9-11, 27].…”

Association of Preoperative Opioid Use With Complication Rates and Resource Use in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

“…This cost relationship is likely explained in large part by our other findings of increased ED visits, need for readmission, and secondary surgery. A similar cost relationship has been demonstrated after spine procedures, 28,33 lower extremity arthroplasty, 61 and shoulder arthroplasty. 6 Thus, it is likely that preoperative opioid use should be considered when calculating preoperative risk of high longitudinal costs of care.…”

Enhanced recovery after surgery in pediatric spine surgery: systematic review

“…ММА позволяет свести к минимуму потребление опиоидов в послеоперационном периоде, что коррелирует с уменьшением сроков госпитализации, финансовых затрат, количества осложнений и побочных эффектов (тошнота и рвота, зуд, гипералгезия, запоры и послеоперационная кишечная непроходимость, острая толерантность к опиоидам, дыхательная недостаточность и др.). Тем не менее внутривенное введение опиоидов в рамках пациент-контролируемой анальгезии (ПКА) по-прежнему является основой послеоперационной анальгезии, поэтому в случаях, когда всетаки необходимо использование опиоидов, могут быть предприняты попытки включить опиоиды короткого действия (суфентанил)[13,33,61,62]. Болееэффективной альтернативой внутривенному введению опиоидов в отношении обезболивания, его длительности и восстановления являются эпидуральный (EPI) и интратекальный (IT) способы введения.…”