Opioid Use Prior to Adult Spine Deformity Correction Surgery is Associated With Worse Pre- and Postoperative Back Pain and Prolonged Opioid Demands.

Autor:	Sardi JP; Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA., Smith JS; Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA., Gum JL; Norton Leatherman Spine Center, Louisville, KY, USA., Rocos B; Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, NC, USA., Charalampidis A; Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.; Department of Clinical Science, Intervention and Technology (CLINITEC), Karolinska Institutet, Stockholm, Sweden., Lenke LG; Department of Orthopedic Surgery, Columbia University, New York, NY, USA., Shaffrey CI; Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, NC, USA., Cheung KMC; Department of Orthopaedic & Traumatology, The University of HK, Hong Kong.; The HKU-Shenzhen Hospital, Shenzhen China., Qiu Y; The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China., Matsuyama Y; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan., Pellisé F; Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain., Polly DW Jr; University of Minnesota, Minneapolis, MN, USA.; Texas Children's Hospital, Houston, TX, USA., Sembrano JN; University of Minnesota, Minneapolis, MN, USA.; Texas Children's Hospital, Houston, TX, USA., Dahl BT; Texas Children's Hospital, Houston, TX, USA., Kelly MP; Rady Children's Hospital, San Diego, CA, USA., de Kleuver M; Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands., Spruit M; St. Maartenskliniek, Nijmegen, Netherlands., Alanay A; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine. Istambul, Turkey., Berven SH; University of California San Francisco Spinal Disorders Service, San Francisco, CA, USA., Lewis SJ; Toronto Western Hospital, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Global spine journal [Global Spine J] 2024 Jun 04, pp. 21925682241261662. Date of Electronic Publication: 2024 Jun 04.
DOI:	10.1177/21925682241261662
Abstrakt:	Study Design: Prospective multicenter database post-hoc analysis. Objectives: Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes. The purpose of this study was to evaluate pre-/postoperative opioid consumption surrounding ASD and assess patient-reported pain outcomes in older patients undergoing surgery for spinal deformity. Methods: Patients ≥60 years of age from 12 international centers undergoing spinal fusion of at least 5 levels and a minimum 2-year follow-up were included. Patient-reported outcome scores were collected using the Numeric Rating Scale for back and leg pain (NRS-B; NRS-L) at baseline and at 2 years following surgery. Opioid use, defined based on a specific question on case report forms and question 11 from the SRS-22r questionnaire, was assessed at baseline and at 2-year follow-up. Result: Of the 219 patients who met inclusion criteria, 179 (81.7%) had 2-year data on opioid use. The percentages of patients reporting opioid use at baseline (n = 75, 34.2%) and 2 years after surgery (n = 55, 30.7%) were similar ( P = .23). However, at last follow-up 39% of baseline opioid users (Opi) were no longer taking opioids, while 14% of initial non-users (No-Opi) reported opioid use. Regional pre- and postoperative opioid use was 5.8% and 7.7% in the Asian population, 58.3% and 53.1% in the European, and 50.5% and 40.2% in North American patients, respectively. Baseline opioid users reported more preoperative back pain than the No-Opi group (7.0 vs 5.7, P = .001), while NRS-Leg pain scores were comparable (4.8 vs 4, P = .159). Similarly, at last follow-up, patients in the Opi group had greater NRS-B scores than Non-Opi patients (3.2 vs 2.3, P = .012), but no differences in NRS-Leg pain scores (2.2 vs 2.4, P = .632) were observed. Conclusions: In this study, almost one-third of surgical ASD patients were consuming opioids both pre- and postoperatively world-wide. There were marked international variations, with patients from Asia having a much lower usage rate, suggesting a cultural influence. Despite both opioid users and nonusers benefitting from surgery, preoperative opioid use was strongly associated with significantly more back pain at baseline that persisted at 2-year follow up, as well as persistent postoperative opioid needs. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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