Does Engaging Patients with Relevant Education About Long-Term Opioid Use Before Spine Surgery Affect Long-term Opioid Use? A Randomized Controlled Trial

Impact of Body Mass Index on Opioid Prescriptions After Lumbar Spine Surgery

OBJECTIVE

This study aimed to evaluate the association between body mass index and postoperative opioid use within 2 yrs after lumbar spine surgery using a national database.

METHODS

TriNetX, a national network of deidentified patient records, was retrospectively queried from 2003 to 2021 using International Classification of Disease 10, Current Procedural Terminology, and Veterans Affairs codes. Propensity score matching analysis was performed based on demographics, comorbidities, anxiety disorders, and mood disorders.

RESULTS

A total of 21,997 patients were included in our analysis. Patients with body mass index ≥ 30 were more likely to be prescribed opioids postoperatively (odds ratio: 1.30; 95% confidence interval: 1.18-1.42). Patients with body mass index ≥ 40 were more likely to be prescribed opioids when compared to patients with body mass index < 30 (odds ratio: 1.94; 95% confidence interval: 1.48-2.56), body mass index 30-34.9 (odds ratio: 2.06; 95% confidence interval: 1.57-2.70), body mass index 35-39.9 (odds ratio: 1.50; 95% confidence interval: 1.13-2.00), and body mass index < 40 (odds ratio: 2.06; 95% confidence interval: 1.57-2.70). The body mass index ≥ 40 group had an increased number of opioid prescriptions within 2 yrs after lumbar surgery compared to patients with body mass index 30-34.9 ( P = 0.0113) and body mass index < 30 ( P = 0.0018).

CONCLUSIONS

Opioid prescription after lumbar spine surgery is associated with an elevated body mass index. Patients with class III obesity seem to be at the highest risk of increased opioid prescriptions after lumbar surgery. Physicians should consider the patient's body mass index when deciding postoperative pain management.

The effect of preoperative education on postoperative pain and function after orthopedic surgery: A systematic review and meta-analysis

OBJECTIVES

To systematically review the effect of preoperative education on reducing postoperative pain and disability in the short-term and long-term for patients undergoing orthopedic surgery.

METHODS

Pertinent randomized controlled trials were retrieved from PubMed, Cochrane Central, Embase, Medline, Scopus and CINAHL from their inception until September 10, 2023. Two authors independently conducted study selection, data extraction, and methodological quality assessment. This review was registered in PROSPERO (CRD42023470282).

RESULTS

A total of 37 RCTs were included with 27 of them being pooled for meta-analysis. Low certainty of evidence indicated that there was a small effect of preoperative education (standardized mean difference = - 0.23, 95 % CI = [- 0.39, - 0.07], p = 0.004) or combined preoperative intervention (standardized mean difference = - 0.25, 95 % CI = [- 0.41, - 0.09], p = 0.003) on postoperative pain relief.

CONCLUSIONS

Preoperative education and combined preoperative intervention only had a short-term effect on postoperative pain relief, while they were not superior to usual care in postoperative functional recovery, either short-term or long-term.

PRACTICE IMPLICATIONS

Both preoperative education and combined preoperative intervention are effective in pain control around a week postoperatively. However, optimal contents, durations, and dose of education warrant further investigation.

Pain Catastrophizing Predicts Opioid and Health-Care Utilization After Orthopaedic Surgery: A Secondary Analysis of Trial Participants with Spine and Lower-Extremity Disorders

BACKGROUND

Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use.

METHODS

This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days' supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration.

RESULTS

Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days' supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = -1.25 [95% CI, -2.38 to -0.12]; p = 0.03) were associated with greater 12-month postsurgical days' supply of opioids. Presurgical opioid days' supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = -0.17 [95% CI, -0.24 to -0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization.

CONCLUSIONS

Greater presurgical days' supply of opioids and pain catastrophizing accounted for greater postsurgical days' supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.