Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

Abstract

<sec><title>Study Design</title><p>Matched cohort study.</p></sec><sec><title>Purpose</title><p>To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids.</p></sec><sec><title>Overview of Literature</title><p>Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed.</p></sec><sec><title>Methods</title><p>A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected.</p></sec><sec><title>Results</title><p>The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, <italic>p</italic>=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, <italic>p</italic>=0.01) and compared with higher users (70, <italic>p</italic>=0.01). In multivariable analysis, “greater expectations” was independently associated with having had chiropractic care (<italic>p</italic>=0.03), being more disabled (<italic>p</italic>=0.002), and being a lower-dose opioid user (<italic>p</italic>=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, <italic>p</italic>=0.003).</p></sec><sec><title>Conclusions</title><p>Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.</p></sec>

Which Factors Affect the Stress of Intraoperative Orthopedic Surgeons by Using Electroencephalography Signals and Heart Rate Variability?

“…However, specifying these predictions with actual numerical values and parameters that have been validated has another important meaning. Numerous studies have been conducted on several factors related to the surgical outcome [30][31][32]. These are the demographic data of the patients before surgery, radiologic parameters of the patients undergoing surgery, and factors related to surgery such as operation time and intraoperative blood loss.…”

More Than 1 in 3 Patients With Chronic Low Back Pain Continue to Use Opioids Long-term After Spinal Fusion

“…10,12 Most patients expect surgery to result in reduced pain and improved function, with less need for opioids. [13][14][15][16] Up to 90% of patients undergoing spinal fusion would define continued narcotic use as an unacceptable outcome. 14 Unfortunately, some studies show that only a small portion of patients who undergo surgery will be able to reduce or eliminate subsequent opioid use.…”

“…Risk factors associated with long-term opioid use in the postoperative population include: male sex, age >50, preoperative opioid use, drug or alcohol abuse, depression, overlapping opioids with other prescriptions, and mean postoperative pain scores 10,12. Most patients expect surgery to result in reduced pain and improved function, with less need for opioids 13–16. Up to 90% of patients undergoing spinal fusion would define continued narcotic use as an unacceptable outcome 14.…”