• Alexander Beletsky, Stephen Music, Cherry Liu, Kim Vickery, Natalie Hurlock, Nutan Winston, Munish Loomba, Tolga Suvar, Jeffrey Chen, and Rodney A Gabriel.
• HCA Healthcare, Department of Anesthesiology, Riverside Community Hospital, Riverside, CA.
• Pain Physician. 2024 Jan 1; 27 (1): 697769-77.

BackgroundOutcome optimization after the placement of a spinal cord stimulator (SCS) is critical. The objective of this study was to determine if an association existed between pre-procedural opioid use (compared to patients who were opioid-naïve) and postoperative long-term outcomes following SCS placement.ObjectiveTo examine the impact of preprocedural opioid use on long-term outcomes after SCS therapy.Study DesignCohort study utilizing a nationwide database.SettingRetrospective.MethodsWith the use of data from HCA Healthcare's national database, a retrospective cohort study was performed to analyze differences in outcomes between opioid-naïve patients and preoperative opioid users who underwent SCS placements. The primary outcome of interest was device explantation at 6 months and 12 months. Secondary outcome measurements included reoperations and readmissions at 6 months and 12 months, as well as operative complications. Multivariable logistic regression models were performed to analyze the association of preoperative opioid use with those outcomes. The odds ratio (OR), 95% confidence intervals (CI), and P values were reported for the independent variables.ResultsThe final study population consisted of 13,893 patients who underwent SCS placements. In univariate analyses, patients who used opioids preoperatively had higher 6-month (3.6% vs. 2.6%) and one-year removal rates (3.6% vs. 2.8%) (all P < 0.009). On multivariable logistic regression, those using opioids preoperatively had higher odds of removal at 6 months (OR = 1.290, 95% CI 1.05-1.58, P = 0.01) and at one year (OR = 1.23, 95% CI 1.01-1.50, P = 0.04). There was no difference between patients requiring preoperative opioids and patients who were opioid-naive as far as the odds of 6- or 12-month readmissions were concerned. Compared to the opioid-naive group, patients requiring preoperative opioids had increased odds of reoperation at 6 months (OR = 1.2, 95% CI 1.02-1.40, P = 0.03). There were no differences in the odds of complications between both cohorts.LimitationsOpioid use in this study was defined as using opioids preoperatively in the 30 days leading up to surgery.ConclusionPatients requiring preoperative opioids before SCS placements had increased odds of SCS explantation at 6 months and 12 months, as well as increased odds of reoperation at 6 months.

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