Retrospective review of electronic medical records (EMR).
This study aims to (1) characterize the pattern of opioid utilization in patients undergoing spine surgery and (2) compare the postoperative course between patients with and without chronic preoperative opioid prescriptions.
Summary of Background Data.
Postoperative pain management for patients with a history of opioid usage remains a challenge for spine surgeons. Opioids
are controversial in this setting due to side effects and potential for abuse and addiction. Given the increasing rate of opioid prescriptions for spine-related pain, more studies are needed to evaluate patterns and risks of preoperative opioid usage in surgical patients.
EMR were reviewed for patients (age > 18) with lumbar spinal stenosis undergoing lumbar laminectomy
in 2011 at our institution. Data regarding patient demographics, levels operated, pre/postoperative medications, and in-hospital length of stay
were collected. Primary outcomes were length of stay
and duration of postoperative opioid usage.
One hundred patients were reviewed. Fifty-five patients had a chronic opioid prescription documented at least 3 months before surgery. Forty-five patients were not on chronic opioid therapy
preoperatively. The preoperative opioid group compared with the non-opioid group had a greater proportion of females (53% vs.
40%), younger mean age (63 yrs vs.
65 yrs), higher frequency of preoperative benzodiazepine prescription (20% vs.
11%), longer average in-hospital length of stay
(3.7 d vs.
3.2 d), and longer duration on postoperative opioids
(211 d vs.
Patients on chronic opioids
prior to spine surgery are more likely to have a longer hospital stay and continue on opioids
for a longer time after surgery, compared with patients not on chronic opioid therapy
. Spine surgeons and pain specialists should seek to identify patients on chronic opioids
before surgery and evaluate strategies to optimize pain management in the pre- and postoperative course.
Level of Evidence: 3