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  • Preoperative narcotic use is associated with worse post-operative self-reported outcomes in patients undergoing spine surgery

    Final Number:
    141

    Authors:
    Stephen Kyle Mendenhall BS; Dennis S Lee MD; Sheyan J Armaghani MD; Jesse E Bible MD; David Shau B.S.; Harrison F. Kay; Chi Zhang BS; Matthew J. McGirt MD; Clinton J. Devin MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Recent national attention has highlighted the negative effects of narcotics in spine surgery and other non-malignant pain settings. Despite this observation, there is a paucity of data on the effect of narcotic consumption and patient reported outcomes in patients undergoing spinal surgery.

    Methods: 583 patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) surgery for a structural lesion were included. Preoperative narcotic consumption was gathered from the medical record and converted to the corresponding daily morphine equivalent amount. Preoperative baseline, 3-month post-operative, and 12-month post-operative SF-12, ODI/NDI, and EQ5D scores were assessed. ODI and NDI scores were combined into a single outcome variable to include both cervical and lumbar patients in simultaneous analysis. Multivariate regression analysis was used to assess the association between preoperative narcotic use and post-operative SF-12, EQ5D, and ODI/NDI scores.

    Results: Univariate analysis revealed that SF-12 scores were significantly improved at both 3 and 12-month follow-up (39.6±11.4 at 3 months, 39.0±13.2 at 12 months, compared to 29.2±9.6 preoperatively, p<0.001), as were EQ5D scores (0.75±0.22 at 3 months, 0.73±0.22 at 12 months, compared to 0.54±0.21 preoperatively, p<0.001). ODI/NDI scores were significantly improved at both follow-up visits (28.7±19.6 at 3 months, 28.4±20.9 at 12 months, compared to 49.2±18.0 preoperatively, p<0.001). Longitudinal multivariable analysis controlling for age, sex, diabetes, smoking, anatomic location, preoperative Modified Somatic Perception Questionnaire (MSPQ) score, preoperative depression, primary vs. revision surgery, and baseline scores revealed that preoperative narcotic use was significantly associated with worse post-operative SF-12, EQ5D, and ODI/NDI scores. Specifically, every 1mg MEA taken preoperatively was associated with a 0.022 decrease in the SF-12 score, a 0.00066 decrease in the EQ5D score, and a 0.048 increase in the ODI/NDI score (p<0.001).

    Conclusions: Our work suggests that increased preoperative narcotic consumption prior to undergoing spinal surgery for a structural lesion is associated with worse patient reported outcomes.

    Patient Care: Our research demonstrates the need for preoperative narcotics weening/intervention when possible to help patients achieve maximum quality of life improvement after spine surgery.

    Learning Objectives: This abstract demonstrates the negative impact that preoperative narcotic consumption has on patient reported outcomes, specifically SF-12, EQ-5D, and ODI/NDI score.

    References:

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