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Association of Patient-Reported Narcotic Use With Short- and Long-Term Outcomes After Adult Spinal Deformity Surgery

Multicenter Study of 425 Patients With 2-year Follow-up

Raad, Micheal MD; Jain, Amit MD; Neuman, Brian J. MD; Hassanzadeh, Hamid MD; Gupta, Munish C. MD; Burton, Douglas C. MD§; Mundis, Gregory M. Jr. MD; Lafage, Virginie PhD||; Klineberg, Eric O. MD; Hostin, Richard A. MD∗∗; Ames, Christopher P. MD††; Bess, Shay MD‡‡; Sciubba, Daniel M. MD; Kebaish, Khaled M. MD; on behalf of the International Spine Study Group

doi: 10.1097/BRS.0000000000002631

Study Design. Retrospective analysis of a prospective registry

Objective. To investigate associations of preoperative narcotic use with outcomes after adult spinal deformity (ASD) surgery.

Summary of Background Data. We hypothesized that preoperative narcotic use would predict longer hospital stays, greater postoperative narcotic use, and greater disability 2 years after ASD surgery.

Methods. A multicenter database of surgical ASD patients was analyzed retrospectively for patients with self-reported data on preoperative narcotic use. Patients were categorized as using narcotics daily or non-daily (including those who used no narcotics), according to self-report. Outcomes were prolonged length of hospital stay (LOS) (>7 days); length of intensive care unit (ICU) stay; and daily narcotic use and Oswestry Disability Index (ODI) scores 2 years postoperatively. Groups were compared by demographic characteristics, pain, disability, radiographic deformity, and surgical invasiveness. Multivariate logistic and linear regression were used to determine associations between preoperative narcotic use and outcomes.

Results. Of 575 patients who met the inclusion criteria, 425 (74%) had complete 2-year follow-up data. Forty-four percent reported daily preoperative narcotic use. Compared with non-daily users, daily narcotic users were older, had more comorbidities, more severe back pain, higher ODI scores, longer operative times, and worse preoperative malalignment and were more likely to undergo 3-column osteotomy (all, P < 0.05). Daily narcotic use independently predicted prolonged LOS (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1–2.9), longer ICU stay (difference = 16 hours, 95% CI = 1.9–30 hours), and daily narcotic use 2 years postoperatively (OR = 6.9, 95% CI = 3.7–13), as well as worse 2-year ODI score (difference = 4.5, 95% CI: 0.7–8.3, P = 0.021).

Conclusion. Daily narcotic use before ASD surgery was associated with prolonged LOS, longer ICU stays, and increased risk of daily narcotic use and greater disability 2 years postoperatively.

Level of Evidence: 3

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD

Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA

Davis Department of Orthopaedic Surgery, University of California, Sacramento, CA

§Department of Orthopaedic Surgery, University of Kansas, Kansas City, KS

Scripps Clinic Medical Group, La Jolla, CA

||Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY

∗∗Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX

††Department of Neurosurgery, University of California-San Francisco Medical Center, San Francisco, CA

‡‡Rocky Mountain Scoliosis and Spine, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO.

Address correspondence and reprint requests to Khaled M. Kebaish, MD, Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD 21287; E-mail:

Received 14 September, 2017

Revised 3 January, 2018

Accepted 2 February, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

DePuy Synthes Spine, K2 M, NuVasive, Biomet, and Orthofix funds were received in support of this work. Grant recipient was the International Spine Study Group Foundation.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, payment for lecture, stocks, patents, royalties.

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