• Siril T Holmberg, Svetlana Skurtveit, Sasha Gulati, Øyvind O Salvesen, Øystein P Nygaard, Tore K Solberg, and Olav M S Fredheim.
• Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
• Spine. 2023 Jul 15; 48 (14): 969977969-977.

Study DesignProspective pharmacoepidemiologic study.ObjectiveTo investigate clinical and sociodemographic factors associated with persistent opioid use in the years following spine surgery among patients with persistent opioid use preceding lumbar spine surgery.Summary Of Background DataIt is unknown whether successful spine surgery leads to a cessation of preoperative persistent opioid use.Materials And MethodsData from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked for patients operated for degenerative lumbar spine disorders between 2007 and 2017. The primary outcome measure was persistent opioid use in the second year after surgery. Functional disability was measured with the Oswestry Disability Index (ODI). Factors associated with persistent opioid use in the year before, and two years following, surgery were identified using multivariable logistic regression analysis. The variables included in the analysis were selected based on their demonstrated role in prior studies.ResultsThe prevalence of persistent opioid use was 8.7% in the year before surgery. Approximately two-thirds of patients also met the criteria for persistent opioid use the second year after surgery. Among patients who did not meet the criteria for persistent opioid use the year before surgery, 991 (3.3%) patients developed persistent opioid use in the second year following surgery. The strongest association was exhibited by high doses of benzodiazepines in the year preceding surgery (OR 1.7, 95% CI 1.26 to 2.19, P <0.001). Among patients without persistent opioid use, the most influential factor associated with new-onset persistent opioid use in the second year after surgery was the use of high doses of benzodiazepines (OR 1.8, 95% CI 1.26 to 2.44, P <0.001), high doses of z -hypnotics (OR 2.6, 95% CI 2.10 to 3.23, P <0.001) and previous surgery at the same lumbar level (OR 1.37, 95% CI 1.11 to 1.68, P =0.003).ConclusionA substantial proportion of patients reported sustained opioid use after surgery. Patients with persistent opioid use before surgery should be supported to taper off opioid treatment. Special efforts appear to be required to taper off opioid use in patients using high doses of benzodiazepines.Level Of Evidence2; Prospective observational study.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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