Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

Abstract

Study Design. Observational case control Objective. Evaluate the prevalence of opioid use at 2 years after surgical correction of adolescent idiopathic scoliosis (AIS) and association with preoperative mental health. Summary of Background Data. Studies of opiate use have reported that up to 80% of users began their addiction with misuse of prescription opioids. Identifying opioid use and those at risk in the AIS population is critical for optimal outcomes. Methods. A query of a multi-center prospective AIS surgical fusion registry was performed to identify patients of all curve types with responses to Question 11 on the SRS-22 questionnaire at 2 years postoperative. Question 11 asks about pain medication usage for the patient’s back with 5 specific responses; narcotics daily, narcotics weekly or less, non-narcotics daily, non-narcotics weekly/less; or none. Ordinal regression was used to evaluate the association between preoperative SRS-22 Mental Health (MH) domain scores and 2 year postoperative pain medication usage. Results. 2595 patients who underwent surgery from 2002-2019 met inclusion. The average primary curve was 56±12°, average age 14.7±3 years, and 81.5% were female. Forty (1.5%) patients reported utilizing opioids 2 years after surgery and a significant difference in preoperative MH scores was observed. Patients taking daily opioids postoperatively had the lowest median preoperative MH score (3.75), followed by non-narcotic group (4), and no medication (4.2,P<0.001). Three patients reporting opioid use postoperatively reported preoperative usage. The rate of 2 year postoperative medication use based on year of surgery demonstrated a small linear decrease in opioid use over time, with a slight increase in non-opioid daily use. Conclusion. Less than 2% of patients reported taking opioids for back pain 2 years after surgical correction of AIS. A lower Mental Health score prior to surgery may place a patient at increased risk for opioid use 2 years after surgery. An analysis of year of surgery suggests that changes in prescription practices over time may be occurring. Level of Evidence. Level 4