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  • Retrospective Review of Preoperative Medical and Psychological Risk Factors Affecting Opioid Use in a Veteran Elective Lumbar Spine Surgery Population

    Final Number:

    Frank M Mezzacappa BS; Kyle Schmidt; Steven Tenny MD, MPH, MBA; Leslie C. Hellbusch

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Opioid abuse is a significant public health concern in the United States. Despite the well-characterized nature of opioid use in the general population, studies concerning factors related to opioids use in veterans is less prevalent. We studied comorbid conditions that affect opioid use in a cohort of veterans who underwent elective lumbar spine surgery.

    Methods: Charts from patients who underwent elective lumbar spinal surgery during a 16-year period at the Veterans Affairs Nebraska-Western Iowa Healthcare Center were reviewed (n=377).  Comorbidities were compared to opioid use in 90-day preoperative and postoperative periods.

    Results: As dichotomous variables, major depression (p=0.0197), hepatitis C (p=0.0207), degenerative joint disease (p=0.0331), alcohol abuse (p=0.0024), and other substance abuse (p=0.0018) are associated with increased preoperative opioid use, while diabetes mellitus type II was associated with increased postoperative opioid use (p=0.035). Lumbar fusion surgery (p<0.0001), allergic rhinitis (p=0.01), obstructive sleep apnea (p=0.02), and 7+ versus 0 total comorbid conditions (p<0.05) resulted in a relative increase in postoperative opioid use. Overall, opioid use has risen slowly during the 16-year study period but has begun to trend downward in recent years.

    Conclusions: Psychiatric comorbidities in this study were not significantly associated with increased opioid usage after lumbar spine surgery while some non-psychiatric conditions were associated with increased opioid use. Psychiatric conditions do not necessarily preclude veteran patients from receiving lumbar spine surgery or indicate risk for increased opioid use in the postoperative period.

    Patient Care: Our findings show specific conditions which may require more opioid pain medication before or after elective lumbar spine surgery allowing neurosurgeons to better identify and deal with such risk factors in their daily practice for patient treatment and counseling.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify potential comorbid conditions leading to increase opioid use in VA spine surgery patients, 2) Identify factors affecting an increase in postoperative opioid use in VA elective lumbar spine surgery patients


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