Nav: Home

For spinal fusion surgery patients, taking opioids before surgery is major risk factor for long-term opioid use

July 26, 2018

July 26, 2018 - Patients taking opioids for at least three months before spinal fusion surgery in the lower spine are much more likely to continue taking opioids one year after surgery , reports a study in Spine . The journal is published in the Lippincott portfolio by Wolters Kluwer.

"We found over 40 percent of chronic preoperative users still were filling opioid prescriptions 12 months after surgery," write Andrew J. Pugely and colleagues of University of Iowa Hospitals and Clinics, Iowa City. Their study includes an online calculator to help surgeons assess the risk of prolonged postoperative opioid use in patients undergoing spinal fusion surgery.

Preoperative Opioids Are Strongest Risk Factor for Prolonged Opioid Use

The study included approximately 26,500 patients undergoing lower spine fusion surgery (lumbar arthrodesis) between 2007 and 2015. Patients were identified from a nationwide insurance database; more than 90 percent were aged 50 years or older and about 60 percent were women.

Overall, about 58 percent of patients had an active opioid prescription within three months before lumbar arthrodesis. Using one-year follow-up data, the researchers compared opioid prescription filling rates for patients with preoperative opioid use (OU) versus "opioid-naive" (ON) patients who didn't take opioids in the three months before surgery.

Throughout the year after spinal fusion, patients who had been taking opioids before surgery were more likely to continue to fill opioid prescriptions:

  • At one month, about 83 percent of patients with preoperative opioid use had filled an opioid prescription, compared to 60 percent of opioid-naive patients.
  • By three months, rates of prescription opioids declined, but remained higher in the OU group: 54 percent, compared to 14 percent in the ON group. After six months, rates of opioid prescriptions leveled off.
  • At one year, about 42 percent of the OU group were still filling opioid prescriptions, compared to nine percent of the ON group.
Preoperative opioid use was by far the strongest predictor of continued opioid use at one year. Risk was more than four times higher for patients in the OU group compared to the ON group. The magnitude of the risk increase varied for different types of spinal fusion surgery.

Other risk factors included depression/anxiety, alcohol abuse, and drug dependence (besides opioids). Based on the risk factors identified, the researchers created an interactive app for surgeons to use in estimating the risk of opioid use one year after spinal fusion surgery.

Studies have shown that opioid use before major orthopedic surgery is associated with worse outcomes as well as an increased risk of prolonged opioid use. Few studies have looked at the outcomes and risk factors for chronic opioid use after spine surgery. Lumbar arthrodesis is widely performed for various types of lower spine disorders.

The new study highlights preoperative opioid consumption as a major risk factor for continued opioid use up to one year after lower spine fusion surgery. "In our experience, this prolonged opioid use after spine fusion surgery may be largely inappropriate," Dr. Pugley and coauthors write. They emphasize that they do not advocate eliminating the use of opioids for pain treatment after spinal surgery: "Opioid overuse should not be confused with appropriate use."

However, they do recommend appropriate steps to prevent long-term opioid use after spinal fusion surgery. Dr. Pugley and colleagues conclude: "The identified risk factors and the proposed clinical utility app can be used as an adjunct to risk stratification and patient counseling for encouraging discontinuation of presurgical narcotic use, and opioid weaning strategies."
-end-
Click here to read "Opioid Utilization Following Lumbar Arthrodesis: Trends and Factors Associated With Long-Term Use"

DOI: 10.1097/BRS.0000000000002734

About Spine

Recognized internationally as the leading journal in its field, Spine (http://www.spinejournal.com) is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. According to the latest ISI Science Citation Impact Factor, Spine is the most frequently cited spinal deformity journal among general orthopaedic journals and subspecialty titles.

About Wolters Kluwer

Wolters Kluwer is a global leader in professional information, software solutions, and services for the health, tax & accounting, finance, risk & compliance, and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer, headquartered in the Netherlands, reported 2017 annual revenues of €4.4 billion. The company serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

Wolters Kluwer Health

Related Opioids Articles:

Opioids for chronic non-cancer pain doubled in quarter century
A review of 24 years of global research has shown opioid prescribing doubled between 1991-2015, with demand most common for chronic conditions such as chronic lower back pain, finds University of Sydney-led research.
Cancer screening among women prescribed opioids
US women who take prescription opioids are no less likely to receive key cancer screenings when compared to women who are not prescribed opioids.
Parents: Turkey makes great leftovers -- opioids do not
Leftover prescription opioids pose big risks to kids, yet most parents keep their own and their child's unused painkillers even after they're no longer medically necessary for pain.
Co-addiction of meth and opioids hinders treatment
A study published in the Journal of Substance Abuse Treatment found that methamphetamine use was associated with more than twice the risk for dropping out of treatment for opioid-use disorder.
Computer game may help to predict reuse of opioids
A computer betting game can help predict the likelihood that someone recovering from opioid addiction will reuse the pain-relieving drugs, a new study shows.
Postpartum women are getting prescribed more opioids than needed
New University of Minnesota Medical School research finds postpartum women are generally getting prescribed more narcotics than they need.
Cannabis found not to be a substitute for opioids
The research team looked at all research on the effects of cannabis use on illicit opioid use during methadone maintenance therapy, which is a common treatment for opioid use disorder, and found six studies involving more than 3,600 participants.
VA investigates impact of opioids, sedatives on veterans
Nearly 20 veterans kill themselves each day in the United States, a statistic that has led the Department of Veterans Affairs to make suicide prevention its highest priority and to recognize the risks from the simultaneous use of opioids and benzodiazepines.
Of all professions, construction workers most likely to use opioids and cocaine
Construction workers are more likely to use drugs than workers in other professions, finds a study by the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU College of Global Public Health.
US-born residents more than 5 times likely to use prescription opioids than new immigrants
The longer immigrants live in the United States, the more likely they are to use prescription opioids -- a fact that contradicts popular views linking wealth and health, and suggests that American culture is uniquely favorable toward prescribing opioids.
More Opioids News and Opioids Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Making Amends
What makes a true apology? What does it mean to make amends for past mistakes? This hour, TED speakers explore how repairing the wrongs of the past is the first step toward healing for the future. Guests include historian and preservationist Brent Leggs, law professor Martha Minow, librarian Dawn Wacek, and playwright V (formerly Eve Ensler).
Now Playing: Science for the People

#565 The Great Wide Indoors
We're all spending a bit more time indoors this summer than we probably figured. But did you ever stop to think about why the places we live and work as designed the way they are? And how they could be designed better? We're talking with Emily Anthes about her new book "The Great Indoors: The Surprising Science of how Buildings Shape our Behavior, Health and Happiness".
Now Playing: Radiolab

The Third. A TED Talk.
Jad gives a TED talk about his life as a journalist and how Radiolab has evolved over the years. Here's how TED described it:How do you end a story? Host of Radiolab Jad Abumrad tells how his search for an answer led him home to the mountains of Tennessee, where he met an unexpected teacher: Dolly Parton.Jad Nicholas Abumrad is a Lebanese-American radio host, composer and producer. He is the founder of the syndicated public radio program Radiolab, which is broadcast on over 600 radio stations nationwide and is downloaded more than 120 million times a year as a podcast. He also created More Perfect, a podcast that tells the stories behind the Supreme Court's most famous decisions. And most recently, Dolly Parton's America, a nine-episode podcast exploring the life and times of the iconic country music star. Abumrad has received three Peabody Awards and was named a MacArthur Fellow in 2011.