Association between Opioid Dose, Acute Post‐operative Pain and Walking Distance Following Lumbar Spine Surgery

Aoyagi, Kosaku; He, Jia; Simpson, Melanie H.; Melton, Brittany L.; Chandaka, Sravani; Waitman, Lemuel R.; Sharma, Neena

doi:10.1111/jcpt.13052

Cited by 4 publications

(1 citation statement)

References 48 publications

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“…Several studies have demonstrated the effect of ambulation in the first week after spine surgery on long-term patient disability, physical function, and postoperative complications; however, the relationship between inpatient physical activity after ASD surgery and postoperative complications in elderly patients has not been fully explored. [3][4][5][6][7][8][9][10][11][12][13][14] The ability of the elderly patient to independently walk as early as possible following ASD surgery may decrease the perioperative complication rate. The present study examines the correlation in clinical outcomes of elderly patients with their ability to ambulate.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Inpatient Step Count on Complications in the Elderly Patient After Adult Spinal Deformity Surgery

et al. 2023

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Background: The number of elderly patients undergoing adult spinal deformity (ASD) surgery has increased with the advent of new techniques and more nuanced understanding of global malalignment as patients age. The relationship between inpatient physical activity after ASD surgery and postoperative complications in elderly patients has not been reported; thus, we sought to investigate this relationship.Methods: We performed a medical record review of 185 ASD patients older than 65 years (age: 71.5 ± 4.7; body mass index: 30.0 ± 6.1, American Society of Anesthesiologists: 2.7 ± 0.5, and levels fused: 10.5 ± 3.4). We derived the number of feet walked over the first 3 days after surgery from physical therapy documentation and evaluated for association with 90-day perioperative complications. Patients who sustained an incidental durotomy were excluded from the study.Results: The 185 patients were divided into groups based on whether they were among the 50th percentile for number of feet walked (62 ft). Walking less than 62 ft after ASD surgery was associated with higher incidence of postoperative complications (54.3%, P = 0.05), cardiac complications (34.8%, P = 0.03), pulmonary complications (21.7%, P = 0.01), and ileus (15.2%, P = 0.03). Patients who developed any postoperative complication (106 ± 172 vs 211 ± 279 ft, P = 0.001), ileus (26 ± 49 vs 174 ± 248 ft, P = 0.001), deep venous thrombosis (23 ± 30 vs 171 ± 247 ft, P = 0.001), and cardiac complications (58 ± 94 vs 192 ± 261 ft) walked less than patients who did not.Conclusion: Elderly patients who walked less than 62 ft in the first 3 days after ASD surgery have a higher rate of postoperative complications, specifically pulmonary and ileus compared with those patients who walked more. Steps walked after ASD surgery may be a helpful and practical addition to the surgeon's armamentarium for monitoring the recovery of their patients.Clinical Relevence: Monitoring the steps walked by patients after ASD surgery can be a practical and useful tool for surgeons to track and improve their patients' recovery.Level of Evidence: 3.

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Section: Introductionmentioning

confidence: 99%

The Effect of Inpatient Step Count on Complications in the Elderly Patient After Adult Spinal Deformity Surgery

et al. 2023

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Tailored Yoga Intervention for Postlumbar Spine Surgical Pain Management: A Feasibility Study

Sharma,

Li,

Aoyagi

et al. 2024

Journal of Integrative and Complementary Medicine

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Postoperative Dexamethasone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Fletcher

Ruska

Austin

et al. 2020

Journal of Bone and Joint Surgery

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Background: Surgeons have hesitated to use steroids in patients undergoing posterior spinal fusion because of the risk of wound complications. The literature has supported the use of postoperative steroids in other areas of orthopaedics on the basis of more rapid recovery and improved postoperative pain control. We hypothesized that a short course of postoperative dexamethasone following posterior spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) would decrease opioid usage without increasing wound-healing problems. Methods: Consecutive patients undergoing posterior spinal fusion for the treatment of AIS from 2015 to 2018 at a single hospital were included. A review of demographic characteristics, curve characteristics, surgical data, and postoperative clinic notes was performed. Opioid usage was determined by converting all postoperative opioids given into morphine milligram equivalents (MME). Results: Sixty-five patients underwent posterior spinal fusion for the treatment of AIS without postoperative steroids (the NS group), and 48 patients were managed with 3 doses of postoperative steroids (the WS group) (median, 8.0 mg/dose). There was no difference between the groups in terms of curve magnitude, number of vertebrae fused, or estimated blood loss. There was a 39.6% decrease in total MME used and a 29.5% decrease in weight-based MME used in the group receiving postoperative steroids (82.0 mg [1.29 mg/kg] in the NS group versus 49.5 mg [0.91 mg/kg] in the WS group]; p < 0.001). This difference persisted after accounting for gabapentin, ketorolac, and diazepam usage; surgical time; curve size; levels fused; and number of osteotomies (median decrease, 0.756 mg/kg [95% CI, 0.307 to 1.205 mg/kg]; p = 0.001). Three patients in the NS group (4.6%) and 4 patients in the WS group (8.3%) developed wound dehiscence requiring wound care (p = 0.53). One patient in the NS group required surgical debridement for the treatment of an infection. Patients in the WS group were more likely to walk at the time of the initial physical therapy evaluation (60.4% versus 35.4%; p = 0.013). Conclusions: A short course of postoperative steroids after posterior spinal fusion was associated with a 40% decrease in the use of opioids, with no increase in wound complications. Surgeons may consider the use of perioperative steroids in an effort to decrease the use of postoperative opioids following posterior spinal fusion for the treatment of AIS. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Association between Opioid Dose, Acute Post‐operative Pain and Walking Distance Following Lumbar Spine Surgery

Cited by 4 publications

References 48 publications

The Effect of Inpatient Step Count on Complications in the Elderly Patient After Adult Spinal Deformity Surgery

The Effect of Inpatient Step Count on Complications in the Elderly Patient After Adult Spinal Deformity Surgery

Tailored Yoga Intervention for Postlumbar Spine Surgical Pain Management: A Feasibility Study

Postoperative Dexamethasone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

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