Depression is associated with poorer outcome of lumbar spinal stenosis surgery

Sinikallio, Sanna; Aalto, Timo; Airaksinen, Olavi; Herno, Arto; Kröger, Heikki; Savolainen, Sakari; Turunen, Veli; Viinamäki, Heimo

doi:10.1007/s00586-007-0349-3

Cited by 140 publications

(93 citation statements)

References 31 publications

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“…2,14,15,16,18,19 In addition, behavioral risk factors such as diagnosis of depression and smoking have both been associated with high self-rated pain scores and higher risk of long term opioid use after spine surgery. 2,11,20,21,22 To date, however, risk factors for long term opioid use after lumbar spinal fusion surgery have not been examined in a large-scale nationally representative study. Ours is the first study to focus on this important healthcare issue using one of the nation’s largest commercial insurance databases.…”

mentioning

confidence: 99%

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Connolly

Javed

Raji

et al. 2017

Spine

120

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Study Design A population-based retrospective cohort study. Objective The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults. Summary of Background Data Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention. Methods Using one of the nation’s largest commercial insurance databases, we conducted a retrospective cohort study of 8,377 adults, aged 21–63 years, who underwent lumbar spinal fusion surgery between January 1, 2009 and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long term opioid use following lumbar fusion. Results After adjusting for covariates, the following factors were associated with an increased risk of long term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR=2.27, 95% CI=1.48–3.49; Quartile 2(23–72 days): OR=5.94, 95% CI=4.00–8.83; Quartile 3: (73–250 days) OR=25.31, 95% CI=17.26–37.10; Quartile 4 (≥ 250days) OR=219.95, 95% CI=148.53–325.71 )], re-fusion surgery (OR=1.32, 95% CI=1.02–1.72), and diagnosis of depression (OR=1.43, 95% CI=1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR=0.79, 95% CI=0.63–0.99). Conclusions These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.

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mentioning

confidence: 99%

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Connolly

Javed

Raji

et al. 2017

Spine

120

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“…Because the absolute risk of abnormal bleeding with SSRIs is low, and uncontrolled depression is associated with poorer surgical outcome, 395 routine discontinuation of SRIs before pain procedures is not recommended. 381,396 Serotonin reuptake inhibitor discontinuation is probably necessary only in high-risk patients with stable depression.…”

Section: Procedural Recommendationsmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Narouze

Benzon

Provenzano³

et al. 2017

Regional Anesthesia and Pain Medicine

114

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The American Society of Regional Anesthesia and Pain Medicine (ASRA) 2012 survey of meeting attendees showed that existing ASRA anticoagulation guidelines for regional anesthesia were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors required separate guidelines for pain and spine procedures. In response, a guidelines committee was formed. After preliminary review of published complications reports and studies, the committee stratified interventional spine and pain procedures according to potential bleeding risk: low-, intermediate-, and high-risk procedures. The ASRA regional anesthesia anticoagulation guidelines were largely deemed appropriate for the low- and intermediate-risk categories, but the high-risk category required further investigation. The first guidelines specific to interventional spine and pain procedures were published in 2015. Recent reviews evaluating bleeding complications in patients undergoing specific interventional pain procedures, the development of new regional anesthesia and acute pain guidelines, and the development of new anticoagulants and antiplatelet medications necessitate complementary updated guidelines. The authors desired coordination with the authors of the recently updated regional and acute pain anticoagulation guidelines. The latest evidence was sought through extensive database search strategies and the recommendations were evidence based when available and pharmacology driven otherwise. We could not provide strength and grading of these recommendations because there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations. This publication is intended as a living document to be updated periodically with consideration of new evidence.

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“…Because the absolute risk of abnormal bleeding with SSRIs is low and uncontrolled depression is associated with poorer surgical outcome, 359 routine discontinuation of SRIs before pain procedures is not recommended. 345,360 The SRI discontinuation is probably necessary only in high-risk patients with stable depression.…”

Section: Procedural Recommendationsmentioning

confidence: 99%

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

Narouze

Benzon

Provenzano³

et al. 2015

Regional Anesthesia and Pain Medicine

264

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Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures. In response, ASRA formed a guidelines committee. After preliminary review of published complication reports and studies, committee members stratified interventional spine and pain procedures according to potential bleeding risk as low-, intermediate-, and high-risk procedures. The ASRA guidelines were deemed largely appropriate for the low- and intermediate-risk categories, but it was agreed that the high-risk targets required an intensive look at issues specific to patient safety and optimal outcomes in pain medicine. The latest evidence was sought through extensive database search strategies and the recommendations were evidence-based when available and pharmacology-driven otherwise. We could not provide strength and grading of these recommendations as there are not enough well-designed large studies concerning interventional pain procedures to support such grading. Although the guidelines could not always be based on randomized studies or on large numbers of patients from pooled databases, it is hoped that they will provide sound recommendations and the evidentiary basis for such recommendations.

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Depression is associated with poorer outcome of lumbar spinal stenosis surgery

Cited by 140 publications

References 31 publications

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition)

Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

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