Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis

Kendall, Mark C.; Alves, Lucas J. Castro

doi:10.1097/bpo.0000000000001177

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Preoperative opioid use [odds ratio (OR): 2.93, P <0.0001], obesity (OR: 1.95, P =0.035), preoperative muscle relaxant prescription (OR: 2.06, P =0.036), and preoperative diagnosis of anxiety (OR: 2.39, P <0.0001) were all noted as predictors of prolonged postoperative opioid use. These are important risk factors for surgeons to identify preoperatively with further study warranted to address criticisms of this study including lack of surgical duration as a confounding variable 8…”

Section: Resultsmentioning

confidence: 99%

“…These are important risk factors for surgeons to identify preoperatively with further study warranted to address criticisms of this study including lack of surgical duration as a confounding variable. 8 While studies assessing postoperative opioid usage at single institutions can be useful for identifying risk factors, they do not take into account patients obtaining medication refills at outside hospitals. A study utilizing the Pennsylvania Prescription Drug Monitoring Program database identified pediatric patients who filled additional opioid prescriptions within 6 months of an orthopaedic procedure.…”

Section: Risk Factors For Increased Opioid Usementioning

confidence: 99%

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What’s New in Pain Management for Pediatric Orthopaedic Surgery

Johnson

Andras

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Improving pain control and decreasing opioid prescription and usage continue to be emphasized across both pediatric and adult populations. The purpose of this review is to provide a comprehensive assessment of recent literature and highlight new advancements pertaining to pain control in pediatric orthopaedic surgery. Methods: An electronic search of the PubMed database was performed for keywords relating to perioperative pain management of pediatric orthopaedic surgery. Search results were filtered by publication date for articles published between January 1, 2015 and December 1, 2020 and yielded 404 papers. Results: A total of 32 papers were selected for review based upon new findings and significant contributions in the following categories: risk factors for increased opioid usage, opioid overprescribing and disposal, nonpharmacologic interventions, nonsteroidal anti-inflammatory drugs, peripheral nerve blocks, spine surgery specific considerations, surgical pathway modifications, and future directions. Conclusions: There have been many advances in pain management for pediatric patients following orthopaedic surgery. Rapid recovery surgical care pathways are associated with shorter length of stay and improved pain control in pediatric spine surgery. Opioid overprescribing continues to be common and information regarding safe opioid disposal practices should be routinely provided for pediatric patients undergoing surgery. Level of Evidence: Level IV-literature review.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Factors For Increased Opioid Usementioning

confidence: 99%

What’s New in Pain Management for Pediatric Orthopaedic Surgery

Johnson

Andras

et al. 2021

Journal of Pediatric Orthopaedics

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“…Our study first proposed a direct association between ASD and subsequent risk of exposure to prescription opioids, regardless of comorbidities of depressive disorder, substance use disorder, and pain disorders. A small sample size study of 11 children with ASD and idiopathic scoliosis revealed that ASD was not related to prolonged postoperative opioid use after spinal fusion surgery (Kendall & Castro Alves, 2019). Johnson et al analyzed data on over 10,000 patients receiving neuropsychoanalytic addiction medicine service and demonstrated that patients maintained on opioids tended to have a diagnosis of ASD (Johnson et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Risk of exposure to prescription opioids in children and adolescents with autism spectrum disorder: A nationwide longitudinal study

et al. 2022

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Whether children and adolescents with autism spectrum disorder (ASD) are more likely to be exposed to prescription opioids than others remains unknown. The Taiwan National Health Insurance Research Database was employed, and 14,849 children and adolescents with ASD and 148,490 age-and sex-matched non-ASD controls were enrolled between 2001 and 2009 and followed up till the end of 2011. Those exposed to prescription opioids during the follow-up period were identified. Patients with ASD were more likely to be exposed to prescription opioids (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 4.50-5.45), including intravenous or intramuscular opioids (HR: 5.80, 95% CI: 5.23-6.43) and oral or transcutaneous opioids (HR: 2.32, 95% CI: 1.87-2.89), than were non-ASD controls. Furthermore, the ASD cohort had the increased likelihood of cumulative exposure of >14 days (HR: 6.19, 95% CI: 4.91-7.79) and >30 days (HR: 7.17, 95% CI: 5.19-9.90) to prescription opioids compared with the control cohort. ASD was a risk factor for exposure to prescription opioids. Close monitoring of prescription opioid use is necessary for at-risk children and adolescents with ASD, such as those having with or chronic pain. We found that patients with ASD were more likely to be exposed to prescription opioids, including intravenous or intramuscular opioids and oral or transcutaneous opioids, than were non-ASD controls. We suggest that close monitoring of prescription opioid use is necessary for at-risk children and adolescents with ASD, such as those having with or chronic pain.

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