Preoperative Opioid Use and Its Association With Perioperative Opioid Demand and Postoperative Opioid Independence in Patients Undergoing Spine Surgery

Armaghani, Sheyan J.; Lee, Dennis S.; Bible, Jesse E.; Archer, Kristin R.; Shau, David N.; Kay, Harrison F.; Zhang, Chi; McGirt, Matthew J.; Devin, Clinton J.

doi:10.1097/brs.0000000000000622

Cited by 220 publications

(201 citation statements)

References 31 publications

Supporting

Mentioning

182

Contrasting

Order By: Relevance

“…A similar result has been demonstrated by Armaghani et al, who determined that BMI was not a risk factor for increased opioid demand in the postanesthesia care unit (PACU) in patients who had undergone elective spinal surgery. 2 These findings suggest that patients with a higher BMI are probably not at risk for excessive opioid intake, and thus postoperative analgesic regimens after ACDF should not be altered based on a patient's BMI. However, narcotics administration will remain an aspect of care that requires constant reevaluation, especially with the advent of new dosing strategies and the increased prevalence of multimodal analgesia protocols.…”

Section: Discussionmentioning

confidence: 82%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

show abstract

Section: Discussionmentioning

confidence: 82%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…9 In view of these numbers, there is widespread concern about long-term opioid dependence among patients who undergo spinal fusion surgery. 3,11,12 Moreover, the efficacy of long-term opioid use for low back pain following spinal fusion surgery is widely debated. 2,11,13 …”

mentioning

confidence: 99%

“…3,11,12 Moreover, the efficacy of long-term opioid use for low back pain following spinal fusion surgery is widely debated. 2,11,13 …”

mentioning

confidence: 99%

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery

Connolly

Javed

Raji

et al. 2017

Spine

120

View full text Add to dashboard Cite

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.

show abstract

“…For example, increased use of opioids for pain control prior to spine surgery was found to be associated with worse postoperative outcomes, such as increased demand for opioids after surgery, and decreased incidence of opioid independence 1 year after surgery. 49,50 This highlights the need for a complete evaluation and screening of each patient prior to opioid use. Evaluation findings may impact subsequent patient counselling and treatment planning.…”

Section: Patient Evaluation and Selectionmentioning

confidence: 99%