OPIOIDS PRE-OP MEAN TROUBLE POST-OP?

Author:  Elizabeth Hofheinz, MPH. M. Ed

A new retrospective economic analysis from Midwest Orthopaedics at Rush and The Ohio State University Wexner Medical Center suggests that lumbar fusion in those with chronic preoperative opioid use should be approached with caution.

The study, “Pre-operative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion,” appears in the March 20, 2018 edition of Spine.

The authors wrote, “A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term postoperatively.”

“On adjusted analysis, preoperative COT [chronic opioid therapy] was found to be a risk factor for 90-day wound complications, pain diagnoses, ED [emergency department] visits, readmission, and continued use postoperatively…”

Frank Phillips, M.D., director of the Division of Spine Surgery at Rush University Medical Center, told OTW, “It was interesting to see the high rate of continued opioid use postoperatively in patients with sustained preoperative opioid use.”

“Post lumbar fusion, patients with long-term pre-operative opioid use had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of complications within one-year post-surgery.”

“Some may suggest that by reducing pain, spinal surgery could reduce opioid use. Our data would suggest that surgeons should approach lumbar fusion with caution in patients with chronic preoperative opioid use given the high rate of continued postoperative opioid use as well as higher than anticipated rates of complications and re-operations.”