Introduction: Narcotic use has increased rapidly in the US in recent years. There is an association between pre-operative narcotic use and increased length of stay, inadequate peri-operative pain control and poor spinal surgery outcomes. Our aim was to investigate patterns of narcotic use in Canadian spinal surgery patients, examine trends over time, and determine the effect of spinal surgery on post-operative narcotic use.
Methods: Retrospective analysis of prospectively-collected data on elective thoracolumbar surgery patients in the Canadian Spine Outcomes and Research Network (CSORN) database. Self-reported narcotic use at baseline, pre-surgery and one year post-operative were compared. Baseline narcotic use by age, gender and presenting complaint was also compared. All patients meeting eligibility criteria from database inception to 2017 were included.
Results: 3,511 patients met inclusion criteria. Over time (<2014 to 2017), there was no statistically significant change in the proportion of patients taking narcotics on a daily (range: 36.9% - 46.5%) or intermittent (range: 16.2% - 24.7%) basis. There was no difference in the frequency of narcotic use at baseline and pre-surgery in patients who waited longer than six weeks for surgery. There were significantly more patients using narcotics with a chief complaint of back pain or radiculopathy than neurogenic claudication (p<0.001), and who were younger (<65 years old) than older (p<0.001). At one year post-operatively, daily narcotic use decreased significantly from baseline (44.4% to 22.9% (p<0.01)).
Conclusions: Narcotic use in spinal surgery patients in Canada is widespread. Although narcotic use might decrease post-operatively, as surgeons we are having little to no impact on our patients’ narcotic use while on the waitlist for surgery. An opportunity may exist to intervene in this critical pre-operative stage to optimize surgical outcomes. Continued efforts to decrease narcotic use should be focused on <65 year old radiculopathy and back pain patients.
Patient Care: Highlight the need to create strategies to decrease narcotic use in elective spinal surgery patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the patterns of narcotic use in Canadian spinal surgery patients, examine trends over time, and determine the effect of spinal surgery on post-operative narcotic use, 2) Discuss, in small groups, opportunities that may exist to intervene in this critical pre-operative stage to optimize surgical outcomes.