Implications of Drug Use Disorders on Spine Surgery

Ferari, Christopher; Katsevman, Gennadiy A.; Dekeseredy, Patricia; Sedney, Cara L.

doi:10.1016/j.wneu.2019.12.177

Cited by 13 publications

(9 citation statements)

References 45 publications

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“…17 Prior work has linked preoperative drug/alcohol use to poorer outcomes, decreased compliance, and higher rates of postoperative complications after arthroplasty and shoulder and spine surgery. 4,17,22,27,35,39,63,64 Trauma populations have a higher prevalence of preinjury drug/alcohol abuse than that of the general population, 23,28,34,46 with several series specifically evaluating the impact of substance abuse on complications following trauma. 6,10,49,51 Our findings echo and contribute to this body of literature.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

et al. 2021

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Background: Early revision rates within 12 months after ankle fracture open reduction internal fixation (AF-ORIF) are fairly low; however, they remain relevant given the volume of ankle fractures occurring annually. Understanding these rates is complex because reoperation due to technical or mechanical complications is typically reported alongside soft tissue–related problems such as symptomatic hardware, wound dehiscence, or infection. There are limited data identifying risk factors specifically for revision of ankle fracture fixation in the absence of soft tissue complications. Understanding variables that predispose to aseptic technical and mechanical failure without this confounder may provide insight and improve patient care. Methods: A retrospective cohort study was performed at 2 large academic medical centers. Research Patient Data Registry (RPDR) data available from 2002 to 2019 were used to identify patients who underwent aseptic revision of AF-ORIF within 12 months (n = 33). A control group (n = 100) was selected by identifying sequential patients who underwent AF-ORIF not requiring revision within 12 months. Multiple factors were recorded for all patients in both cohorts. Each fracture was also evaluated according to the Ankle Reduction Classification System (ARCS) of Chien et al,8 which categorizes biplanar talar displacement in relation to a central tibial plumb line into 1 of 3 grades: A (0-2 mm), B (3-10 mm), and C (>10 mm). Adapted from its original purpose of grading reduction quality, we applied ARCS to pre-reduction radiographs to assess initial fracture displacement. All variables collected were compared in univariate analysis. Variables that achieved significance in univariate comparisons were included as candidates for multivariable analysis. Results: Final multivariable logistic regression modeling demonstrated the following factors to independently predict the need for aseptic revision surgery: documented falls in the early postoperative period (aOR, 298; 95% CI, 15.4, 5759; P < .001), movement-altering disorders (aOR, 81.7; 95% CI, 4.12, 1620; P = .004), a nonanatomic mortise (medial clear space [MCS] > superior clear space [SCS]) on immediate postoperative imaging (aOR, 38.4; 95% CI, 5.53, 267; P < .001), initial coronal plane tibiotalar displacement >10 mm and sagittal plane tibiotalar dislocation (ARCS-C) (aOR vs ARCS-A, 25.8; 95% CI, 2.81, 237; P = .004), substance abuse (aOR, 15.7; 95% CI, 2.66, 92.8; P = .002), and polytrauma (aOR, 12.3; 95% CI, 2.02, 74.8; P = .006). Conclusion: In this investigation we found a notable increase in risk for revision surgery after AF-ORIF for patients who had one of the following: (1) falls in the early postoperative period, (2) movement-altering disorders, (3) a nonanatomic mortise (MCS > SCS) on immediate postoperative imaging, (4) more severe initial fracture displacement, (5) substance abuse, or (6) polytrauma. Identifying these factors may allow surgeons to better understand risk and counsel patients, and may serve as future targets for intervention aimed at improving patient safety and outcomes after ankle fracture ORIF. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

et al. 2021

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“… 9 , 14 At the same time, sequelae from SUD also complicate acute medical care and pain control. 15 Chronic pain among patients with SUD is associated with more mental health disorders, medical conditions, and increased healthcare use. 16 The two diseases seem to potentiate each other in qualitative studies.…”

Section: Discussionmentioning

confidence: 99%

Elective surgery for acute pain in patients with substance use disorder: lessons learned at a rural neurosurgical center. Patient series

Ferari

Katsevman

Dekeseredy

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND The incidence of pain-generating degenerative spinal problems in patients who are currently using or have previously used drugs has increased as substance use disorder (SUD) becomes a chronic, lifelong condition. Health system–level data in recent years indicate a significant increase in patients with coexisting SUD and degenerative disc disease, representing an emerging population. A retrospective electronic medical record review identified seven patients with SUD who underwent elective spine surgery by orthopedic or neurosurgical staff from 2012 to 2021. The authors present two of these illustrative cases and a framework that can be used in the treatment of similar patients. OBSERVATIONS Substances used included opioids, benzodiazepines, barbiturates, cocaine, methamphetamines, hallucinogens, lysergic acid diethylamide, phencyclidine, and cannabis. All were abstaining from drug use preoperatively, with four patients in a formal treatment program. Five patients were discharged with an opioid prescription, and two patients deferred opioids. Three experienced a relapse of substance use within 1 year. All patients presented for follow-up, although two required additional contact for follow-up compliance. LESSONS Perioperative protocols focusing on patient-led care plans, pain control, communication with medication for opioid use disorder providers, family and social support, and specific indicators of possible poor results can contribute to better outcomes for care challenges associated with these diagnoses.

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“…By analyzing the common primary indications for readmission within these patients, it was demonstrated that patients with substance abuse MRFs had the highest rates of infection following the procedure. This finding may be explained by the fact that tobacco abuse [15,45,46], alcoholism [47À49], and opioid abuse [50,51] have been shown to independently increase the risk of systemic and surgical-site infections (SSI). This finding, while not novel, is important because it demonstrates a higher associated risk with substance abuse when compared to dietary and vascular MRF cohorts, which also independently increase postoperative infection rates, as shown in previous studies [19,38,52,53].…”

Section: Discussionmentioning

confidence: 99%

The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis

et al. 2021

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Background: Modifiable risk factors (MRFs) represent patient variables associated with increased complication rates that may be prevented. There exists a paucity of studies that comprehensively analyze MRF subgroups and their independent association with postoperative complications in patients undergoing cervical spine surgery. Therefore, the purpose of this study is to compare outcomes between patients receiving cervical spine surgery with reported MRFs. Methods: Retrospective analysis of the Nationwide Readmissions Database (NRD) from the years 2016 and 2017, a publicly available and purchasable data source, to include adult patients undergoing cervical fusion. MRF cohorts were separated into three categories: substance abuse (alcohol, tobacco/nicotine, opioid abuse); vascular disease (hypertension, dyslipidemia); and dietary factors (malnutrition, obesity). Three-way nearest-neighbor propensity score matching for demographics, hospital, and surgical characteristics was implemented. Findings: We identified 9601 with dietary MRFs (D-MRF), 9654 with substance abuse MRFs (SA-MRF), and 9503 with vascular MRFs (V-MRF). Those with D-MRFs had significantly higher rates of medical complications (9.3%), surgical complications (8.1%), and higher adjusted hospital costs compared to patients with SA-MRFs and V-MRFs. Patients with D-MRFs (16.3%) and V-MRFs (14.0%) were independently non-routinely discharged at a significantly higher rate compared to patients with SA-MRFs (12.6%) (p<0.0001 and p = 0.0037). However, those with substance abuse had the highest readmission rate and were more commonly readmitted for delayed procedure-related infections. Interpretation: A large proportion of patients who receive cervical spine surgery have potential MRFs that uniquely influence their postoperative outcomes. A thorough understanding of patient-specific MRF subgroups allows for improved preoperative risk stratification, tailored patient counseling, and postoperative management planning.

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Implications of Drug Use Disorders on Spine Surgery

Cited by 13 publications

References 45 publications

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

Risk Factors for Aseptic Revision of Operatively Treated Ankle Fractures

Elective surgery for acute pain in patients with substance use disorder: lessons learned at a rural neurosurgical center. Patient series

The influence of modifiable risk factors on short-term postoperative outcomes following cervical spine surgery: A retrospective propensity score matched analysis

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