Introduction: Narcotics remain a common agent class used for the management of pain in patients being evaluated for spinal surgery. Recent national attention has highlighted the negative effects of narcotics in this and other non-malignant pain settings. Previous work suggests narcotic use and psychiatric comorbidities are intimately related. Among other psychosocial considerations, anxiety level, depression and payer status may be associated with the degree of preoperative narcotic use in patients undergoing spine surgery.
Methods: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Preoperative narcotic consumption was garnered from the medical record and converted to the corresponding daily morphine equivalent amount (MEA). Payer status was recorded as either federal Medicare/Medicaid, private, state Medicaid, uninsured/indigent, or Veterans Affairs/government. Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were recorded as measures of depression and anxiety, respectively. Linear regression analysis was performed including other clinically and psychosocially important covariates. These included age, gender, type of surgery, smoking status, and preoperative employment status.
Results: Linear regression analysis controlling for age, gender, type of surgery, smoking status, and preoperative employment status demonstrated that payer status were not significantly associated with preoperative narcotic use. MSPQ and ZDS scores were significantly associated with the degree of preoperative narcotic use (correlation coefficient 1.26 and 0.777, respectively, p < 0.01).
Conclusions: Payer status does not appear to be associated with the degree of preoperative narcotic use in patients undergoing spine surgery for a structural lesion. Anxiety and depression were significantly associated with narcotic use, underscoring the importance of thorough psychosocial and substance use evaluation in patients being evaluated for spine surgery.
Patient Care: Our research demonstrates that increased preoperative anxiety and depression leads to decreased narcotic independence at 1 year. Surgeons can select high risk patients to undergo psychosocial intervention preoperatively to help achieve quicker narcotic independence.
Learning Objectives: This abstract demonstrates that payer status is not associated with the degree of preoperative narcotic usage. Additionally, it examines the relationship of anxiety and depression with postoperative narcotic consumption.