Preoperative Opioid Prescribers and Lumbar Fusion Their Effect on Clinical Outcomes and Postoperative Opioid Usage

被引:2
|
作者
Lambrechts, Mark J. [1 ,3 ]
Toci, Gregory R. [1 ]
Fried, Tristan B. [1 ]
Issa, Tariq Z. [1 ]
Karamian, Brian A. [1 ]
Carter, Michael V. [1 ]
Breyer, Garrett M. [1 ]
Curran, John G. [1 ]
Hassan, Waqas [1 ]
Jeyamohan, Hareindra [1 ]
Minetos, Paul D. [1 ]
Stolzenberg, David [2 ]
Mehnert, Michael [2 ]
Canseco, Jose A. [1 ]
Woods, Barrett I. [1 ]
Kaye, Ian David [1 ]
Hilibrand, Alan S. [1 ]
Kepler, Christopher K. [1 ]
Vaccaro, Alexander R. [1 ]
Schroeder, Gregory D. [1 ]
机构
[1] Thomas Jefferson Univ, Rothman Inst, Dept Orthoped Surg, Philadelphia, PA USA
[2] Thomas Jefferson Univ, Rothman Inst, Dept Phys Med & Rehabil, Philadelphia, PA USA
[3] Thomas Jefferson Univ, Rothman Orthoped Inst, 925 Chestnut St, 5thFloor, Philadelphia, PA 19107 USA
来源
CLINICAL SPINE SURGERY | 2023年 / 36卷 / 08期
关键词
opioid; narcotic; transforaminal lumbar interbody fusion; posterolateral lumbar fusion; pain management; prescribers; prescription drug-monitoring program; substance use disorder; pain specialist; CLINICALLY IMPORTANT DIFFERENCE; CHRONIC PAIN; PRIMARY-CARE; FUSION; SURGERY; DEPRESSION; PREDICTION; MANAGEMENT; DISABILITY; OUTCOMES;
D O I
10.1097/BSD.0000000000001465
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design: Retrospective cohort study.Objective: To determine the impact of multiple preoperative opioid prescribers on postoperative patient opioid usage and patient-reported outcome measures after single-level lumbar fusion.Summary of Background Data: Prior literature has identified opioid prescriptions from multiple postoperative providers increase opioid usage rates. However, there is limited evidence on how multiple preoperative opioid prescribers affect postoperative opioid usage or clinical outcomes after a single-level lumbar fusion.Patients and Methods: A retrospective review of single-level transforaminal lumbar interbody fusion or posterolateral lumbar fusions between September 2017 and February 2020 at a single academic institution was performed. Patients were excluded if they were not identifiable in our state's prescription drug-monitoring program. Univariate comparisons and regression analyses identified factors associated with postoperative clinical outcomes and opioid usage.Results: Of 239 patients, 160 (66.9%) had one or fewer preoperative prescribers and 79 (33.1%) had >1 prescribers. On regression analysis, the presence of multiple preoperative prescribers was an independent predictor of increased improvement in Visual Analog Scale ( increment VAS) Back (beta=-1.61, P=0.012) and the involvement of a nonoperative spine provider was an independent predictor of increased improvement in increment VAS Leg (beta = -1.53, P = 0.034). Multiple preoperative opioid prescribers correlated with an increase in opioid prescriptions postoperatively (beta = 0.26, P = 0.014), but it did not significantly affect the amount of morphine milligram equivalents prescribed (beta = -48.79, P = 0.146). A greater number of preoperative opioid prescriptions predicted worse improvements in VAS Back, VAS Leg, and Oswestry Disability Index and predicted increased postoperative opioid prescriptions, prescribers, and morphine milligram equivalents.Conclusions: Multiple preoperative opioid prescribers predicted increased improvement in postoperative back pain, whereas preoperative involvement of a nonoperative spine provider predicted improvements in leg pain after surgery. The number of preoperative opioid prescriptions was a better metric for predicting poor postoperative outcomes and increased opioid consumption compared with the number of preoperative opioid prescribers.
引用
收藏
页码:E375 / E382
页数:8
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