Clinical Research Director Norton Leatherman Spine Center Louisville, KY, US
Disclosure(s):
Leah Carreon, MD, MSc: No relevant disclosure to display
Introduction: The use of opioids in management of non-malignant pain has been a topic of interest to surgeons and politicians worldwide. Recent guidelines recommend limiting or avoiding preoperative opioid use, but high preoperative usage prevalence challenges implementation. The purpose of this study is to describe long-term opioid use following lumbar surgery to treat degenerative spine disease, and to characterize the foremost risk factors associated with prolonged opioid use.
Methods: This is observational study using a large cohort of 14082 patients enrolled in DaneSpine during the period 2016-2022, and where all data is collected prospectively. Inclusion criteria were patients undergoing primary lumbar surgery to treat spinal stenosis, spondylolisthesis and disc herniation. Patients with incomplete entries of pain medication, demographics, PROMs, and details of the surgical procedure and complications during the hospitalization were excluded.
Results: Data on pre- and postoperative use of pain medicine and opioids were available for 14,082 patients who underwent spine surgery for spinal stenosis (N=7,932), disc herniation (N=4,573) and spondylolisthesis (N=1,577). 36% of patients were on prescription opioids before surgery, at one-year follow up 17% of patients were persistent users. Patients with preoperative opioid use had an increased relative risk (RR) of 4.58 (p < 0.001) of being prolonged opioid users for the entire cohort, which was strongest for patients with spinal stenosis (RR=5.33, p< 0.001). Modifiable risk factors for prolonged postoperative opioid use included pain duration (RR=2.00), smoking (RR=1.65), prior surgery (RR=2.00) and comorbidities (RR=1.61).
Conclusion : Preoperative opioid use, duration of pain, smoking and high BMI were all predictors for prolonged opioid use. Especially patients who underwent surgery due to spinal stenosis, who were on opioids before surgery, seem to have difficulty coming off opioids within one-year after surgery. This questions the current guidelines of prolonged conservative treatment and the prescription of opioids for back pain.