Details

Autor(en) / Beteiligte

• Steele, Portia
• Gum, Jeffrey L.
• Crawford, Charles H.
• Owens, R. Kirk
• Djurasovic, Mladen
• Brown, Morgan
• Glassman, Steven D.
• Carreon, Leah Y.

Titel

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 69. Immediate postoperative narcotic use is not associated with preoperative opiate use or surgery invasiveness

Ist Teil von

• The spine journal, 2018-08, Vol.18 (8), p.S34-S34

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

2018

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• In 2016 alone, 19,413 deaths were attributed to prescription opioid overdoses.  Understanding the drivers of opiate consumption in postoperative lumbar spinal fusion patients is a high priority. To determine if surgical invasiveness and/or preoperative opiate use influences immediate postoperative opiate consumption. Propensity matched longitudinal cohort. Patients from a multi-surgeon, single spine specialty center with degenerative lumbar pathology who underwent an instrumented posterior lumbar decompression and interbody fusion (MIDLIF or TLIF). Oswestry Disability Index, morphine equivalent doses (MED) from postoperative day (POD) #0 through POD #4. A single-center, multi-surgeon, retrospective review identified patients with degenerative lumbar pathology who underwent an instrumented posterior lumbar decompression and interbody fusion (MIDLIF or TLIF). Patients in each cohort were propensity-matched based on age, sex, smoking status, BMI, diagnosis, ASA grade and levels fused. MED POD #0 through POD #4 were calculated.  Preoperative opiate prescriptions were recorded to determine baseline opioid use. Of 214 MIDLIF and 281 TLIF patients undergoing surgery, 33 patients in each cohort were successfully propensity matched with no differences in baseline characteristics. There was no difference in immediate postoperative mean total MED between the cohorts (MIDLIF=370, TLIF=302, p=.398). Forty-three (65%) of patients were taking opiates prior to surgery. Opiate-naïve patients required less narcotics (MED=248) compared to nonopiate naive patients (MED=383, p=.071) but this was not significant. Patients taking opiates preop had worse baseline ODI (56.5 vs. 47.2, p=.023) and 1-year postop ODI (46.3 vs. 30.9, p=.015). Neither surgical invasiveness nor preoperative opiate use have an impact on immediate postop opiate consumption.  This is likely secondary to non-individualized prescribing patterns.  Patients taking preop narcotics have worse baseline, 1-year, and improvement in ODI following 1- and 2-level MIDLIFs or TLIFs. This abstract does not discuss or include any applicable devices or drugs.