Spine surgery patients who take prescription opioids for an extended period before the procedure are more likely to continue using opioids several months after surgery, according to a new study published in The Journal of Bone & Joint Surgery.
The findings reveal that nearly nine percent of patients were still taking opioids six months after spinal surgery, and the duration of opioid use pre-surgery was the main risk factor for continued use.
The ongoing opioid crisis in the United States has prompted increased attention to the use of pain medications prescribed before and after surgery. Previous opioid use has been associated with a greater risk of complications and negative outcomes after spinal surgery.
The new study focused on how preoperative opioid use may impact continued opioid use after lumbar spine surgery, and finds evidence of a “dose-response” effect: patients taking opioids for a longer period before surgery are less likely to discontinue opioid use after surgery.
The study was led by Dr. Andrew J. Schoenfeld, MD, MSc, of Brigham and Women’s Hospital, Harvard Medical School. Using insurance claims data, the researchers identified more than 27,000 patients who underwent various types of lower (lumbar) spine surgery between 2006 and 2014. Most had undergone the removal of a spinal disc (discectomy) or spinal fusion (arthrodesis).
The data came from the U.S. Department of Defense’s Tricare insurance program, but most of the patients in the study were civilians (such as retired military personnel or dependents of active-duty or retired personnel).
Nearly all patients had at least some pre-surgery opioid exposure. They were classified into four groups:
- exposed: 60 percent had used opioids in the past, but were not actively using them at the time of surgery;
- acute exposure: 34 percent had their first opioid prescription within one month before surgery;
- intermediate sustained use: two percent had uninterrupted opioid use for less than six months before surgery;
- chronic sustained use: three percent had uninterrupted opioid use for six months or longer before surgery.
After surgery, the study finds that 67 percent of the patients stopped taking opioids within 30 days, and 86 percent discontinued opioids by 90 days. Six months after surgery, 8.8 percent of patients were still taking prescription opioids.
Longer duration of opioid use before spinal surgery was an independent risk factor for continued use after surgery. After adjustment for other factors, the researchers found that the likelihood of discontinuing opioid use within six months was 65 percent lower for patients in the “intermediate sustained” and 74 percent lower in the “chronic sustained” groups, compared to the “acute exposure” group.
One surprising finding was that among patients who had been “exposed” to opioids previously but were not actively using opioids right before surgery were 29 percent less likely than those in the “acute exposure” group to discontinue opioids after surgery.
Several other factors were associated with long-term opioid use after surgery: spinal fusion surgery, preoperative depression or anxiety, preoperative spinal fracture, a longer hospital stay, and junior enlisted rank (suggesting lower socioeconomic status).
“Our results indicate that the majority of patients who are using prescription opioids prior to spine surgery discontinue these medications following surgical intervention,” Schoenfeld and coauthors write.
However, since approximately 1 in 10 patients are still taking opioids at six months after spinal surgery, the researchers highlight the need for surgeons to recognize the “biopsychosocial” factors contributing to chronic opioid use.
Source: Wolters Kluwer Health