Sex Differences in Opioid Use in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis Undergoing Lumbar Decompression and Fusion.
Adult
Aged
Analgesics, Opioid
/ adverse effects
Decompression, Surgical
/ adverse effects
Female
Humans
Lumbar Vertebrae
/ surgery
Male
Middle Aged
Opioid-Related Disorders
/ diagnosis
Pain, Postoperative
/ diagnosis
Retrospective Studies
Sex Characteristics
Spinal Fusion
/ adverse effects
Spinal Stenosis
/ diagnosis
Spondylolisthesis
/ diagnosis
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jul 2019
01 Jul 2019
Historique:
entrez:
18
6
2019
pubmed:
18
6
2019
medline:
21
8
2019
Statut:
ppublish
Résumé
Retrospective analysis. To investigate sex differences in opioid use after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Recent studies have demonstrated higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Furthermore, differences in responsivity to pharmacological and non-pharmacological treatments have been observed. Whether sex differences in perioperative opioid use exists in patients undergoing lumbar fusion for symptomatic stenosis or spondylolisthesis remains unknown. An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1,2, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Records were searchable by International Classification of diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6-months prior to through 2-years after index surgery was assessed. The primary outcome was sex differences in opioid use after index lumbar surgery. The secondary outcome was independent predictors of prolonged opioid use after lumbar fusion. Of the 13,257 participants (females: 7871, 59.8%), 58.4% of women used opioids compared with 56.9% of men prior to index surgery. At 1-year after surgery, continuous opioid use was observed in 67.1% of women compared with 64.2% of men (P < 0.001). Within 2-years postoperatively, opioid use was observed in 83.1% of women versus 82.5% men. In a multivariate logistic regression analysis, female sex (odds ration [OR] 1.14, 95% confidence interval [CI]: 1.058-1.237), obesity (OR 1.10, 95% CI: 1.004-1.212), and preoperative narcotic use (OR 3.43, 95% CI: 3.179-3.708) was independently associated with prolonged (>1 yr) opioid use after index surgery. We observed a higher prevalence of chronic opioid use among women following lumbar fusion surgery. Female sex was independently associated with prolonged opioid use after index surgery. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective analysis.
OBJECTIVE
OBJECTIVE
To investigate sex differences in opioid use after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Recent studies have demonstrated higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Furthermore, differences in responsivity to pharmacological and non-pharmacological treatments have been observed. Whether sex differences in perioperative opioid use exists in patients undergoing lumbar fusion for symptomatic stenosis or spondylolisthesis remains unknown.
METHODS
METHODS
An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1,2, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Records were searchable by International Classification of diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6-months prior to through 2-years after index surgery was assessed. The primary outcome was sex differences in opioid use after index lumbar surgery. The secondary outcome was independent predictors of prolonged opioid use after lumbar fusion.
RESULTS
RESULTS
Of the 13,257 participants (females: 7871, 59.8%), 58.4% of women used opioids compared with 56.9% of men prior to index surgery. At 1-year after surgery, continuous opioid use was observed in 67.1% of women compared with 64.2% of men (P < 0.001). Within 2-years postoperatively, opioid use was observed in 83.1% of women versus 82.5% men. In a multivariate logistic regression analysis, female sex (odds ration [OR] 1.14, 95% confidence interval [CI]: 1.058-1.237), obesity (OR 1.10, 95% CI: 1.004-1.212), and preoperative narcotic use (OR 3.43, 95% CI: 3.179-3.708) was independently associated with prolonged (>1 yr) opioid use after index surgery.
CONCLUSION
CONCLUSIONS
We observed a higher prevalence of chronic opioid use among women following lumbar fusion surgery. Female sex was independently associated with prolonged opioid use after index surgery.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 31205178
doi: 10.1097/BRS.0000000000002965
pii: 00007632-201907010-00016
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Pagination
E800-E807Références
Malon J, Shah P, Koh WY, et al. Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database. BMC Public Health 2018; 18:810.
Pleis JR, Ward BW, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital Health Stat 2010; 10:1–207.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013; 111:52–58.
Berkley KJ. Sex differences in pain. Behav Brain Sci 1997; 20:371–380. discussion 435-513.
Unruh AM. Gender variations in clinical pain experience. Pain 1996; 65:123–167.
Exploring the biological contributions to human health: does sex matter? J Womens Health Gend Based Med 2001; 10:433–439.
Zeidan A, Al-Temyatt S, Mowafi H, et al. Gender-related difference in postoperative pain after laparoscopic Roux-En-Y gastric bypass in morbidly obese patients. Obes Surg 2013; 23:1880–1884.
Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg 2003; 97:1464–1468.
Aubrun F, Salvi N, Coriat P, et al. Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology 2005; 103:156–160.
Soetanto AL, Chung JW, Wong TK. Are there gender differences in pain perception? J Neurosci Nurs 2006; 38:172–176.
Neziri AY, Scaramozzino P, Andersen OK, et al. Reference values of mechanical and thermal pain tests in a pain-free population. Eur J Pain 2011; 15:376–383.
Kröner-Herwig B, Gaßmann J, Tromsdorf M, et al. The effects of sex and gender role on responses to pressure pain. Psychosoc Med 2012; 9:Doc01.
Storesund A, Krukhaug Y, Olsen MV, et al. Females report higher postoperative pain scores than males after ankle surgery. Scand J Pain 2016; 12:85–93.
Hucho TB, Dina OA, Kuhn J, et al. Estrogen controls PKCepsilon-dependent mechanical hyperalgesia through direct action on nociceptive neurons. Eur J Neurosci 2006; 24:527–534.
Loyd DR, Murphy AZ. The neuroanatomy of sexual dimorphism in opioid analgesia. Exp Neurol 2014; 259:57–63.
Zubieta JK, Smith YR, Bueller JA, et al. mu-opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci 2002; 22:5100–5107.
Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med 2005; 2:137–145.
Kochanek KD, Murphy S, Xu J, et al. Mortality in the United States, 2016. NCHS Data Brief 2017; 1–8.
Mobini A, Mehra P, Chigurupati R. Postoperative pain and opioid analgesic requirements after orthognathic surgery. J Oral Maxillofac Surg 2018; 76:2285–2295.
Bedard NA, Pugely AJ, Westermann RW, et al. Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 2017; 32:2390–2394.
Mogil JS, Chesler EJ, Wilson SG, et al. Sex differences in thermal nociception and morphine antinociception in rodents depend on genotype. Neurosci Biobehav Rev 2000; 24:375–389.
Hassan S, Muere A, Einstein G. Ovarian hormones and chronic pain: a comprehensive review. Pain 2014; 155:2448–2460.
Niesters M, Dahan A, Kest B, et al. Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies. Pain 2010; 151:61–68.
Kaur S, Stechuchak KM, Coffman CJ, et al. Gender differences in health care utilization among veterans with chronic pain. J Gen Intern Med 2007; 22:228–233.
Eriksen J, Sjøgren P, Ekholm O, et al. Health care utilisation among individuals reporting long-term pain: an epidemiological study based on Danish National Health Surveys. Eur J Pain 2004; 8:517–523.