• World Neurosurg · Mar 2020

    Opioid Use, Risk Factors, and Outcome in Lumbar Fusion Surgery.

    • Nasya Mendoza-Elias, Melissa Dunbar, Zoher Ghogawala, and Robert G Whitmore.
    • Alan L. and Jacqueline B. Stuart Spine Research Center, Department of Neurosurgery, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA; Section of Neurosurgery, University of Chicago, Chicago, Illinois, USA. Electronic address: nasya.mendoza-elias@uchospitals.edu.
    • World Neurosurg. 2020 Mar 1; 135: e580e587e580-e587.

    ObjectiveInappropriate opioid use resulted in 68% of all U.S. drug overdoses in 2017-nearly 75% of all opioid deaths-costing $80 billion per year. It is imperative to understand the impact of opioid use on outcome from surgery for lower back pain disorders.MethodsA retrospective review of lumbar spinal fusion registry data at a single center from 2015-2018 was performed. A novel algorithm was used to extract opioid utilization from the electronic health record. Number of levels fused, fusion type, and minimally invasive surgery status were collected from the registry, as were depression status, European Quality of Life 5 level score, and Oswestry Disability Index at 6 months to 1 year postoperatively.ResultsWe included 294 patients (mean age 62 years, 48% male). Patients younger than 65 years trended toward more opioid use before surgery and significantly higher opioid use after surgery (P < 0.0001). Depression trended toward increasing opioid use after surgery (P = 0.08). Fusions of 4 or more levels were associated with overall greater opioid use after surgery (P = 0.03). Higher rate of opioid use before and after surgery is associated with worse European Quality of Life 5 level scores after surgery (P = 0.01 and P = 0.04) and worse Oswestry Disability Index scores after surgery (P = 0.006 and P = 0.002).ConclusionsThis registry finds that younger age and lower functional status scores are associated with higher opioid use before surgery. Opioid use before surgery, younger age, and >4 levels of fusion are associated with higher opioid use after surgery. Overall, opioid use is associated with worse functional outcome and may serve as a marker of disease progression.Copyright © 2019 Elsevier Inc. All rights reserved.

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