The Effects of Chronic Preoperative Opioid Use on Single-level Lumbar Fusion Outcomes.
Adult
Analgesics, Opioid
/ administration & dosage
Female
Humans
Insurance Claim Review
Low Back Pain
/ prevention & control
Lumbar Vertebrae
Male
Middle Aged
Outcome Assessment, Health Care
Pain Measurement
Pain, Postoperative
Preoperative Period
Reoperation
Retrospective Studies
Spinal Fusion
United States
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
7
3
2020
medline:
12
10
2021
entrez:
6
3
2020
Statut:
ppublish
Résumé
A retrospective study using a national insurance claims database. The objective of this study was to assess the relationship between chronic preoperative opioids and the outcomes of revision surgery and nonunion after single-level lumbar fusion. Opioids are widely utilized for pain management before spine procedures. Studies have associated opioids with unfavorable postoperative outcomes, and animal models have also linked opioid administration with unstable bone healing. Single-level lumbar fusion patients were identified. Patients with any fracture history within 1 year before surgery were excluded. A chronic preoperative opioid cohort was defined by opioids prescriptions within 3 months prior and within 4-6 months before surgery. The rates of revision surgery within 6 months and nonunion within 6-24 months after surgery were assessed. Univariate analyses of chronic preoperative opioid prescriptions and various comorbidities for revision and nonunion were conducted followed by multivariate analyses controlling for these factors. Individual analyses were run for each of the 3 single-level lumbar fusion procedures. A total of 8494 single-level lumbar fusion patients were identified. Of the 3929 (46.3%) patients filled criteria for the chronic preoperative opioid cohort, while 3250 (38.3%) patients had no opioid prescriptions within 6 months before surgery. The opioid cohort experienced significantly higher rates of both revisions (3.92% vs. 2.71%, P=0.005) and nonunion (3.84% vs. 2.89%, P=0.027) relative to the opioid-naive cohort. In the multivariate analyses, chronic preoperative opioids were identified as an independent risk factor for revision (odds ratio: 1.453, P=0.006). We report that chronic opioid prescriptions before lumbar fusion may increase the risk of revision. Although these prescriptions were also associated with increased nonunion, the comparisons did not achieve statistical significance in the multivariate model. Chronic preoperative opioid use may be considered a potential risk factor in arthrodesis populations.
Sections du résumé
STUDY DESIGN
A retrospective study using a national insurance claims database.
OBJECTIVE
The objective of this study was to assess the relationship between chronic preoperative opioids and the outcomes of revision surgery and nonunion after single-level lumbar fusion.
SUMMARY OF BACKGROUND DATA
Opioids are widely utilized for pain management before spine procedures. Studies have associated opioids with unfavorable postoperative outcomes, and animal models have also linked opioid administration with unstable bone healing.
METHODS
Single-level lumbar fusion patients were identified. Patients with any fracture history within 1 year before surgery were excluded. A chronic preoperative opioid cohort was defined by opioids prescriptions within 3 months prior and within 4-6 months before surgery. The rates of revision surgery within 6 months and nonunion within 6-24 months after surgery were assessed. Univariate analyses of chronic preoperative opioid prescriptions and various comorbidities for revision and nonunion were conducted followed by multivariate analyses controlling for these factors. Individual analyses were run for each of the 3 single-level lumbar fusion procedures.
RESULTS
A total of 8494 single-level lumbar fusion patients were identified. Of the 3929 (46.3%) patients filled criteria for the chronic preoperative opioid cohort, while 3250 (38.3%) patients had no opioid prescriptions within 6 months before surgery. The opioid cohort experienced significantly higher rates of both revisions (3.92% vs. 2.71%, P=0.005) and nonunion (3.84% vs. 2.89%, P=0.027) relative to the opioid-naive cohort. In the multivariate analyses, chronic preoperative opioids were identified as an independent risk factor for revision (odds ratio: 1.453, P=0.006).
CONCLUSIONS
We report that chronic opioid prescriptions before lumbar fusion may increase the risk of revision. Although these prescriptions were also associated with increased nonunion, the comparisons did not achieve statistical significance in the multivariate model. Chronic preoperative opioid use may be considered a potential risk factor in arthrodesis populations.
Identifiants
pubmed: 32134746
doi: 10.1097/BSD.0000000000000953
pii: 01933606-202010000-00015
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E401-E406Références
Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303:1259–1265.
Lee C, Dorcil J, Radomisli TE. Nonunion of the spine: a review. Clin Orthop Relat Res. 2004;419:71–75.
Kao FC, Hsu YC, Wang CB, et al. Short-term and long-term revision rates after lumbar spine discectomy versus laminectomy: a population-based cohort study. BMJ Open. 2018;8:e021028.
Rienmüller AC, Krieg SM, Schmidt FA, et al. Reoperation rates and risk factors for revision 4 years after dynamic stabilization of the lumbar spine. Spine J. 2019;19:113–120.
Lee CS, Hwang CJ, Lee SW, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009;18:1637–1643.
Weick J, Bawa H, Dirschl DR, et al. Preoperative opioid use is associated with higher readmission and revision rates in total knee and total hip arthroplasty. J Bone Joint Surg Am. 2018;100:1171–1176.
Chrastil J, Sampson C, Jones KB, et al. Postoperative opioid administration inhibits bone healing in an animal model. Clin Orthop Relat Res. 2013;471:4076–4081.
Jain N, Himed K, Toth JM, et al. Opioids delay healing of spinal fusion: a rabbit posterolateral lumbar fusion model. Spine J. 2018;18:1659–1668.
Trasolini NA, McKnight BM, Dorr LD. The opioid crisis and the orthopedic surgeon. J Arthroplasty. 2018;33:3379.e1–3382.e1.
Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015;23:267–271.
Smith SR, Bido J, Collins JE, et al. Impact of preoperative opioid use on total knee arthroplasty outcomes. J Bone Joint Surg Am. 2017;99:803–808.
Morris BJ, Sciascia AD, Jacobs CA, et al. Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty. J Shoulder Elbow Surg. 2016;25:619–623.
Armaghani SJ, Lee DS, Bible JE, et al. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine. 2014;39:E1524.
Lee D, Armaghani S, Archer KR, et al. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am. 2014;96:e89.
Medicare Fee for Service 2012 Report. 2013. Available at: www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/Downloads/MedicareFeeforService2012ImproperPaymentsReport.pdf. Accessed December 23, 2018.
Eisenstein TK, Hilburger ME. Opioid modulation of immune responses: effects on phagocyte and lymphoid cell populations. J Neuroimmunol. 1998;83:36–44.