• World Neurosurg · Apr 2020

    Case Reports

    Implications of Drug Use Disorders on Spine Surgery.

    • Christopher S Ferari, Gennadiy A Katsevman, Patricia Dekeseredy, and Cara L Sedney.
    • West Virginia University School of Medicine, Morgantown, West Virginia, USA.
    • World Neurosurg. 2020 Apr 1; 136: e334-e341.

    BackgroundThe opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUDs).ObjectiveTo investigate the outcomes of patients with SUD who undergo spine surgery.MethodsA retrospective chart review was performed on patients with SUD who underwent nonelective spine surgery by orthopedic or neurosurgical staff from 2012 to 2017 at a level 1 trauma center and spine referral center. Three elective cases were excluded.ResultsA total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 patients using multisubstances (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice and 22% (11/49) did not follow up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program preoperatively versus 39% (19/49) postoperatively. Sixty-five percent (32/49) were prescribed opioids in the immediate postoperative period and 47% (23/49) continued to abuse drugs postoperatively.ConclusionsPatients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional perioperative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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