Preoperative Opioid Score Does Not Predict Patient Outcomes After Spinal Surgery

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An opioid use score based on state prescription databases does not predict complications or other adverse outcomes in patients undergoing spinal surgery, according to a study published in the journal Spine.

The increasingly used NarxCare narcotics score does not predict adverse outcomes or patient dissatisfaction after elective spine surgery, according to Anoop Raj Galivanche, Yale University School of Medicine, New Haven, Connecticut, and colleagues. “Although there are many reasons to address preoperative patient narcotic utilisation, the current study did not identify perioperative outcome/satisfaction differences based on preoperative narcotics use criteria,” the authors noted.

The study included 346 patients undergoing elective spinal surgery at the authors’ hospital over a 6-month period. The hospital routinely estimated each patient’s previous use of opioid pain medications with the automated NarxCare narcotic score.

The NarxCare score approximates a patient’s level of previous opioid use, calculated from state prescription drug monitoring programmes. The score accounts for number and dosage of opioid prescriptions, along with the number of prescribers, number of pharmacies, and overlapping prescriptions. NarxCare scores range from 0 (no previous opioid use) to 999 (highest level of use).

On admission to the hospital for spinal surgery, nearly 80% of patients had a NarxCare score of greater than zero, indicating at least 1 recent opioid prescription. About 6% were in the highest category of NarxCare score (500 or higher). The researchers evaluated whether the preoperative NarxCare score could predict patient outcomes after spinal surgery. About 4% of patients had some type of adverse event.

After controlling for other patient characteristics, the rate of adverse outcomes was not significantly different for patients at different levels of NarxCare score. That included both minor and serious adverse events, as well as the rates of repeat surgery or repeat hospitalisation. (There were no deaths within 30 days after surgery.)

NarxCare scores were also unrelated to patient satisfaction scores – increasingly viewed as an important indicator of the quality of healthcare.

“In light of the fact that federal reimbursement may be affected by [patient satisfaction] scores, these findings are particularly relevant,” Galivanche and colleagues conclude.