Chronic opioid use after spine surgery: what is the prescription for reducing opioid dependence?

Esfahani, Kamilla; Naik, Bhiken I.; Dunn, Lauren K.

doi:10.21037/jss.2018.11.01

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…term relief for some patients, their use is associated with a host of physical, psychological, and socioeconomic issues [4,5]. Our cohort demonstrated significant preoperative differences on the basis of narcotic use in terms of demographics and physical and mental health.…”

Section: Discussionmentioning

confidence: 84%

“…Narcotic use is prevalent among patients with degenerative pathology of the lumbar spine and especially so among those who eventually undergo spinal surgery [ 2 , 3 ]. Although narcotic medications may provide short-term relief for some patients, their use is associated with a host of physical, psychological, and socioeconomic issues [ 4 , 5 ]. Our cohort demonstrated significant preoperative differences on the basis of narcotic use in terms of demographics and physical and mental health.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment may be indicated to alleviate symptoms when conservative measures fail to relieve intense pain caused by degeneration of the lumbar spine. Risks of narcotic dependence and addiction are well documented in lumbar spine surgery patients and can contribute to the substance abuse epidemic [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

et al. 2022

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This study aimed to assess the relationship between preoperative narcotic consumption and patient-reported outcomes (PRO) in patients undergoing minimally invasive (MIS) lumbar decompression (LD). Overview of Literature: Previous studies report negative effects of narcotic consumption on perioperative outcomes and recovery; however, its impact on quality of life and surgical outcomes is not fully understood. Methods: A surgical database was retrospectively reviewed for patients undergoing primary, single-level MIS LD from 2013 to 2020. Patients lacking preoperative narcotic consumption data were excluded. Demographics, spinal pathologies, and operative characteristics were collected. Patients were grouped based on preoperative narcotic consumption. Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-item Short Form Physical Component Summary, and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) were collected preoperatively and postoperatively. Preestablished values were used to calculate achievement of minimum clinically important difference (MCID). Differences in mean PROs and MCID achievement between groups were evaluated. Results: The cohort was 453 patients; 184 used preoperative narcotics and 269 did not. Significant differences were found in American Society of Anesthesiologists classification, ethnicity, insurance type, and estimated blood loss between groups. Significant differences were also found in preoperative PHQ-9, VAS leg, ODI, and PROMIS-PF between groups (all p<0.05). Mean postoperative PROs did not differ by group (p>0.05). A higher rate of MCID achievement was associated with the narcotic group for PHQ-9 and PROMIS-PF at 6 weeks (both p≤0.050), VAS leg at 1 year (p=0.009), and overall for ODI and PHQ-9 (both p≤0.050). Conclusions: Preoperative narcotic consumption was associated with worse preoperative depression, leg pain, disability, and physical function. In patients consuming preoperative narcotics, a higher proportion achieved an overall MCID for disability and depressive symptoms. Patients taking preoperative narcotic medications may report significantly worse preoperative PROs but demonstrate greater improvements in postoperative disability and mental health.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

et al. 2022

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“…Patients who are currently under the care of a pain management physician or have a documented diagnosis of anxiety disorder receive additional counseling regarding the risks of developing opioid dependence after surgery and additional coaching related to alternative pain management techniques including multimodal analgesia, cryotherapy, and mindfulness. This intervention is performed on the basis of evidence that long-term preoperative opioid use and anxiety are risk factors for developing opioid dependence after spine surgery (Armaghani et al, 2013; Esfahani et al, 2018; Kalakoti et al, 2018). In addition, navigators document whether a patient appears subjectively anxious about the upcoming surgery based on clinical judgment.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery

Turcotte

Menon

Andersen

et al. 2021

Orthopaedic Nursing

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Beyond the spine-specific pathology, patient factors such as associated medical and psychosocial conditions, understanding of the treatment process, and the degree of patient activation—defined as the ability of the individual to utilize the available information and actively engage in making their healthcare decisions—can influence outcomes after posterolateral lumbar fusion (PLF) surgery. A retrospective observational cohort study of 177 patients undergoing PLF at a single institution was conducted. Patient demographics, medical and psychosocial risk factors, and outcomes were compared between patients who attended a nurse navigator-led group preoperative education course and those who did not. Patients attending the course were younger, more likely to undergo one-level fusion, less likely to undergo 5- or more-level fusion, and had less comorbidity burden as measured by the hierarchical condition categories score. No differences in psychosocial risk factors were observed between groups. Course attendees had a significantly shorter length of stay (2.12 vs. 2.60 days, p = .042) and decreased average hospital cost (U.S. $10,149 vs. U.S. $14,792, p < .001) than those who did not attend; no differences in other outcomes were observed. After controlling for differences in risk factors, patients enrolled in a preoperative education course demonstrated a statistically significant reduction in hospital cost (β=−4,143, p < .001). Preoperative education prior to PLF surgery may reduce hospital cost, possibly through increased patient activation. Given the relatively high prevalence of psychosocial risk factors in this and similar patient populations, optimizing patient activation and engagement is important to achieve high value care. Based on our findings, nurse navigator-led preoperative education appears to be valuable in this patient population and should be included in enhanced recovery protocols.

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Chronic opioid use after spine surgery: what is the prescription for reducing opioid dependence?

Cited by 2 publications

References 10 publications

The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

The Influence of Preoperative Narcotic Consumption on Patient-Reported Outcomes of Lumbar Decompression

The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery

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