Daily Opioid Users Fare Worse Post-Spine Surgery
A new study from Johns Hopkins has found that adults who had surgery for spinal deformities and had used opioids daily experienced worse outcomes than those who did not use opioids preoperatively. Some of the problems were longer intensive care unit stays and more severe postop disability. This is the first study to examine the effects of opioids on adult spinal deformities (ASD).
The study, “Association of Patient-reported Narcotic Use with Short- and Long-term Outcomes After Adult Spinal Deformity Surgery: Multicenter Study of 425 Patients With 2-year Follow-up,” appears in the March 13, 2018 edition of Spine.
Micheal Raad, M.D., an orthopedic surgery research fellow at the Johns Hopkins University School of Medicine and co-author on the paper, told OTW, “Dr. Khaled Kebaish, the senior author on this paper and my mentor, has centered his practice on complex adult spinal deformity patients.”
“He has frequently questioned the variation in outcome following surgery on different patients’ population; especially among those patients with heavy opioid use, as they appeared to do worse after surgery.”
“In light of the opioid epidemic, we thought this is a very important issue to highlight these patients.”
“Obtaining the data was a challenge. Luckily though, Dr. Kebaish is a member of the International Spine Study Group, a study group that has been collecting very comprehensive and high-quality data in the adult spinal deformity patient population.”
“Although that was a good starting point, information about opioid use was not collected, or so we thought. The study group gives patient surveys with more than 120 questions as part of their efforts to understand how the disease affects patient’s Health Related Quality of Life. Eventually, we realized that the key to opioid information actually lies on one of those questions which asks patients about their opioid use in detail.”
The authors wrote, “Of 575 patients who met the inclusion criteria, 425 (74%) had complete 2-year follow-up data. Forty-four percent reported daily preoperative narcotic use. Compared with non-daily users, daily narcotic users were older, had more comorbidities, more severe back pain, higher ODI [Oswestry disability Index] scores, longer operative times, and worse preoperative malalignment and were more likely to undergo 3-column osteotomy. Daily narcotic use independently predicted prolonged LOS [length of stay], longer ICU stay, and daily narcotic use 2 years postoperatively, as well as worse 2-year ODI score.”
Dr. Raad commented to OTW, “While the impact of opioid use on hospital length of stay and ICU length of stay was interesting, we thought that the long-term effects were astounding.”
“Patients who were using opioids heavily in the preoperative period were more likely to have higher levels of disability and were 6.9 times more likely to be using opioids heavily at two years after surgery. This is a very important consideration, particularly in a time and age where researchers and physicians are directing large amounts of resources to curb long-term opioid use in patients.”
