Long-Term Opioid Prescriptions After Spine Surgery: A Meta-Analysis of Prevalence and Risk Factors

Lo, Yu Tung; Lim-Watson, M.; Seo, Yookyung; Fluetsch, Noemi; Alasmari, Moudi M.; Alsheikh, Mona Yaser; Lamba, Nayan; Smith, Timothy R.; Aglio, Linda S.; Mekary, Rania A.

doi:10.1016/j.wneu.2020.06.081

Cited by 27 publications

(27 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering the increasing utilization of outpatient and ambulatory surgical centers for spine procedures 28 and the high rates of opioid usage after certain spine surgeries, 29 spine patients should be treated as a high-risk surgical population with regards to opioid use. Hence, there is need to explore the relationships between pain management following orthopedic care within the context of the current opioid epidemic and the patients who suffer the consequences.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018

Kim

Brodeur

Gil

et al. 2022

Spine

View full text Add to dashboard Cite

Objective. Considering the high rates of opioid usage following orthopedic surgeries, it is important to explore this in the setting of the current opioid epidemic. This study examined acute opioid poisonings in postoperative spine surgery patients in New York and the rates of poisonings among these patients in the context of New York’s 2016 State legislation limiting opioid prescriptions. Methods. Claims for adult patients who received specific orthopedic spine procedures in the outpatient setting were identified from 2009 to 2018 in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Patients were followed to determine if they presented to the emergency department for acute opioid poisoning postoperatively. Multivariable logistic regression was performed to evaluate the effect of patient demographic factors on the likelihood of poisoning. The impact of the 2016 New York State Public Health Law Section 3331, 5. (b), (c) limiting opioid analgesic prescriptions was also evaluated by comparing rates of poisoning prelegislation and postlegislation enactment. Results. A total of 107,456 spine patients were identified and 321 (0.3%) presented postoperatively to the emergency department with acute opioid poisoning. Increased age [odds ratio (OR)=0.954, P<0.0001] had a decreased likelihood of poisoning. Other race (OR=1.322, P=0.0167), Medicaid (OR=2.079, P<0.0001), Medicare (OR=2.9, P<0.0001), comorbidities (OR=3.271, P<0.0001), and undergoing multiple spine procedures during a single operative setting (OR=1.993, P<0.0001) had an increased likelihood of poisoning. There was also a significant reduction in rates of postoperative acute opioid poisoning in patients receiving procedures postlegislation with reduced overall likelihood (OR=0.28, P<0.0001). Conclusion. There is a higher than national average rate of acute opioid poisonings following spine procedures and increased risk among those with certain socioeconomic factors. Rates of poisonings decreased following a 2016 legislation limiting opioid prescriptions. It is important to define factors that may increase the risk of postoperative opioid poisoning to promote appropriate management of postsurgical pain.

show abstract

Section: Discussionmentioning

confidence: 99%

Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018

Kim

Brodeur

Gil

et al. 2022

Spine

View full text Add to dashboard Cite

show abstract

“…After examining opioid utilization in the 12 months before surgery, we categorized everyone with an opioid fill 30 days or more before surgery as being a prior opioid user because prior opioid use is a strong predictor of postoperative opioid use. 1,[16][17][18] Finally, the Opioid Risk Tool (ORT) score, a validated tool to determine at-risk individuals for opioid-related aberrant behaviors, 19 was also taken at baseline. Pain intensity (11-point Numeric Pain Rating Scale, 0-10, worst pain in the last week) was assessed at baseline and after undergoing surgery (1 and 6 months) as a secondary outcome.…”

Section: Discussionmentioning

confidence: 99%

Engaging Education About Risks of Opioid Use With Patients Before Elective Surgery of the Lower Extremity Did Not Reduce Postoperative Opioid Utilization: A Randomized Controlled Trial

Rhon

Greenlee

Mayhew

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Introduction: After elective orthopaedic surgery, many individuals go on to become long-term opioid users. Mitigating this risk has become a priority for surgeons, other members of the medical care team, and healthcare systems. The purpose of this study was to compare opioid utilization after lower extremity orthopaedic surgery between patients who received an interactive video education session highlighting the risks of opioid use and those who did not. Methods: Patients undergoing elective surgery of the lower extremity in the orthopaedic clinic at the Brooke Army Medical Center between July 2015 and February 2017 were recruited at their preoperative appointment and randomized in a 1:1 ratio to receive a one-time interactive opioid education session or usual care education. Unique days' supply of opioids and unique prescriptions were compared using a generalized linear model. Individuals were also grouped by whether they had become long-term opioid users after surgery, and frequencies within each intervention group were compared. Results: There were 120 patients, 60 randomized to each group and followed for 1 year. There were no significant differences between opioid days' supply (mean diff = 8.33, 95% confidence interval 24.21 to 20.87) and unique prescriptions after surgery (mean diff = 0.45, 95% confidence interval 20.25 to 1.15). Most participants did not have any opioids past the initial 30 days after surgery, regardless of intervention (n = 77), and only three became long-term opioid users (one in usual care and two in interactive education). Sixteen in usual education and 18 in enhanced education filled at least one prescription in 6 months or later after the surgical procedure.

show abstract

“…The most consistent variable associated with chronic postop opioid use is preoperative narcotics use, maintaining significance at the meta-analytic level of evidence. 13,[34][35][36] A commonality of the methodology with many previous studies is that their samples are from insurance databases, thus lacking patient-level granularity. A few studies at the single-or oligo-center level have confirmed the above findings while also revealing more nuanced associations.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

Montgomery

Pernik

Johnson

et al. 2021

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

show abstract

Long-Term Opioid Prescriptions After Spine Surgery: A Meta-Analysis of Prevalence and Risk Factors

Cited by 27 publications

References 60 publications

Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018

Postoperative Pain Management Following Orthopedic Spine Procedures and Consequent Acute Opioid Poisoning: An Analysis of New York State From 2009 to 2018

Engaging Education About Risks of Opioid Use With Patients Before Elective Surgery of the Lower Extremity Did Not Reduce Postoperative Opioid Utilization: A Randomized Controlled Trial

Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

Contact Info

Product

Resources

About