Chronic Opioid Use Before Spine Surgery Linked to Longer Opioid Use After Surgery

But how have advancing surgical technique and new opioid regulations affected post-surgical use?

Peer Reviewed

Patients on chronic opioids before undergoing decompression laminectomy of the lumbar spine had a more than twofold longer duration of opioid use post-surgery and a trend toward a longer hospital stay, according to a 2020 retrospective study in Spine. Spine surgeons and pain specialists should evaluate strategies to optimize pain management both before and after spine surgery in patients on chronic opioids for low back pain, the study authors said.

Opioids laminectomyChronic opioid use before a laminectomy is linked to longer opioid use after a laminectomy.

The study included 100 adults with lumbar spinal stenosis undergoing primary lumbar laminectomy at a single institution in 2011 who were followed for at least a year postoperatively. More than half of the group (55 patients) were on taking opioids for least 3 months before surgery (i.e., chronic opioid users). In this chronic opioid group, the average duration of opioid use preoperatively was 7.6 months and the average daily dose was 35 morphine-equivalents (MME; range: 5-240 MME/day).

The relatively high rate of chronic opioid use preoperatively (55%) is consistent with prior studies in the literature, Kha et al noted. Additionally, a SpineUniverse patient survey from 2015 found that 76% of respondents were taking opioids to manage their low back/sacral pain.

Opioid Use Preoperatively Significantly Predicts Longer Postoperative Use

Patients on chronic opioids preoperatively used opioids for a significantly longer duration postoperatively than patients not on chronic opioid therapy preoperatively (211 days versus 79 days; P=0.0010).

Additionally, 9 patients (16%) in the chronic opioid group continued using opioids at 1 year postoperatively compared with only 2 patients (4%) not on chronic opioids preoperatively (P=0.1051).

Trend Toward Longer Hospital Stay in Chronic Opioid Group

The chronic opioid group had a 0.5 day longer hospital stay than the non-opioid group. While this difference was not statistically significant (3.7 days vs. 3.2 days; P=0.1009), the researchers pointed to three other studies showing a statistically significant increased duration in hospital length of stay and complication rates following lumbar in patients with opioid use disorder or dependence preoperatively.1-3

Patients on chronic opioid therapy before surgery were more likely to be female, younger, current or former cigarette smokers, and have a preoperative benzodiazepine prescription (Table). The researchers noted that a history of substance use or abuse may contribute to chronic opioid use preoperatively given that the opioid group had a greater proportion of current or former cigarette smokers and benzodiazepine prescriptions. The groups were similar in terms of number of operative levels (2) and the proportion of patients with a history of spine surgery (42%-44%).

Table. Factors Linked to Chronic Opioid Use Before Lumbar Laminectomy

Variable

Chronic Opioid Group (n=55)

Nonopioid Group

(n=45)

Female

29 (53%)

18 (40%)

Mean age, years

63

65

Preoperative benzodiazepine prescription

20%

11%

Cigarette use (current or former)

69%

55%

Source: Kha et al. Spine (Phila Pa 1976). 2020;45(7):438-443.

“Early identification of patients with these known risk factors can better inform healthcare professionals and patients of the risk for adverse outcomes with opioid therapy and promote discussion towards alternative options for pain management,” the researchers concluded.

Older Data May No Longer Be Representative

Jason Highsmith, MD, a neurosurgeon at Charleston Brain and Spine, points out that the data in this study don’t tell the whole story. “This paper uses data from almost ten years ago when hospital stays and post-operative narcotic courses were much longer,” he said. “Regardless, the trend for long-term narcotics was concerning in patients with pre-operative exposure. In the last decade surgeons have made tremendous progress towards performing laminectomies as short stay procedures.” 

Dr. Highsmith says the patients in this study are no longer representative of laminectomy performance or recover. “In my practice, I rarely keep any patient overnight let alone three nights as was the case with this group of non-instrumented cases,” he said. “Similarly with new narcotics regulations I rarely prescribe narcotics for more than a week or two.”

Updated on: 04/07/20
Continue Reading
Do You Screen Your Surgical Patients for Psychological Comorbidities?
Jason M. Highsmith, MD
SHOW MAIN MENU
SHOW SUB MENU
Cancel
Delete

Get new patient cases delivered to your inbox

Sign up for our healthcare professional eNewsletter, SpineMonitor.
Sign Up!