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Montgomery EY, Pernik MN, Johnson ZD, Dosselman LJ, Christian ZK, Deme PR, Adeyemo EA, Barrie U, Badejo O, Stewart NA, Uttarkar R, Adogwa O, Tecle NE, Aoun SG, Bagley CA. Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery. Global Spine J 2023; 13:1450-1456. [PMID: 34414800 PMCID: PMC10448093 DOI: 10.1177/21925682211035723] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective case control. OBJECTIVES The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. METHODS In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. RESULTS Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race (P = 0.001), preoperative narcotic (P < 0.001) or anxiety/depression medication use (P = 0.002), and intraoperative long lumbar (P < 0.001) or thoracic spine surgery (P < 0.001). Lower patient income was also a risk factor for script renewal (P = 0.01). Script renewal at 12 months was associated with younger age (P = 0.006), preoperative narcotics use (P = 0.001), and ≥4 levels of lumbar fusion (P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA (P > 0.05). CONCLUSION The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.
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Affiliation(s)
- Eric Y. Montgomery
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Mark N. Pernik
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Zachary D. Johnson
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Luke J. Dosselman
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Zachary K. Christian
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Palvasha R. Deme
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Emmanuel A. Adeyemo
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Umaru Barrie
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Nick A. Stewart
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ruta Uttarkar
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Saint Louis University School of Medicine, MO, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA
- Department of Orthopedic Surgery, University of Texas Southwestern Medical School, TX, USA
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Potru S, Tang YL. Chronic Pain, Opioid Use Disorder, and Clinical Management Among Older Adults. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:294-302. [PMID: 34690595 PMCID: PMC8475938 DOI: 10.1176/appi.focus.20210002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Because of unique factors related to physiological changes and altered metabolism in advanced age, special attention is needed concerning chronic pain, opioid use, and opioid use disorder among older adults. Clinicians need to follow the most updated clinical guidelines regarding opioid prescribing. Routine screening and awareness are the keys to identifying opioid use disorder. Comprehensive assessments often require both pain assessment (including functional status) and substance use assessment, including the use of urine toxicological testing and structured, validated screening tools and instruments. Comprehensive, interdisciplinary efforts are critical in managing the care of older adults with chronic pain and opioid use disorder. A collaborative approach that includes substance abuse treatment and pain management (including pain subspecialty care) is often recommended. Medications for opioid use disorder have been extensively studied and have the most convincing evidence to date, and psychosocial treatments may be beneficial in some circumstances.
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Affiliation(s)
- Sudheer Potru
- Department of Anesthesiology (Potru) and Department of Psychiatry and Behavioral Sciences (Tang), both at Emory University, Atlanta; Department of Anesthesiology (Potru) and Substance Abuse Treatment Program (Tang), both at Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yi-Lang Tang
- Department of Anesthesiology (Potru) and Department of Psychiatry and Behavioral Sciences (Tang), both at Emory University, Atlanta; Department of Anesthesiology (Potru) and Substance Abuse Treatment Program (Tang), both at Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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