Lee Dennis, Armaghani Sheyan, Archer Kristin R, Bible Jesse, Shau David, Kay Harrison, Zhang Chi, McGirt Matthew J, Devin Clinton
Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee:
Carolina Neurosurgery & Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204.
J Bone Joint Surg Am. 2014 Jun 4;96(11):e89. doi: 10.2106/JBJS.M.00865.
Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. The objective of this investigation was to assess whether preoperative opioid use predicts worse self-reported outcomes in patients undergoing spine surgery.
Five hundred and eighty-three patients undergoing lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion were included in this prospective cohort study. Self-reported preoperative opioid consumption data were obtained at the preoperative visit and were converted to the corresponding daily morphine equivalent amount. Patient-reported outcome measures were assessed at three and twelve months postoperatively via the 12-Item Short-Form Health Survey and the EuroQol-5D questionnaire, as well as, when appropriate, the Oswestry Disability Index and the Neck Disability Index. Separate multivariable linear regression analyses were then performed.
At the preoperative evaluation, of the 583 patients, 56% (326 patients) reported some degree of opioid use. Multivariable analyses controlling for age, sex, diabetes, smoking, surgery invasiveness, revision surgery, preoperative Modified Somatic Perception Questionnaire score, preoperative Zung Depression Scale score, and baseline outcome score found that increased preoperative opioid use was a significant predictor (p < 0.05) of decreased 12-Item Short-Form Health Survey and EuroQol-5D scores, as well as of increased Oswestry Disability Index and Neck Disability Index scores at three and twelve months postoperatively. Every 10-mg increase in daily morphine equivalent amount taken preoperatively was associated with a 0.03 decrease in the 12-Item Short-Form Health Survey physical component summary and mental component summary scores, a 0.01 decrease in the EuroQol-5D score, and a 0.5 increase in the Oswestry Disability Index and Neck Disability Index score at twelve months postoperatively. Higher preoperative Modified Somatic Perception Questionnaire and Zung Depression Scale scores were also significant negative predictors (p < 0.05).
Increased preoperative opioid consumption, Modified Somatic Perception Questionnaire score, and Zung Depression Scale score prior to undergoing spine surgery predicted worse patient-reported outcomes. This suggests the potential benefit of psychological and opioid screening with a multidisciplinary approach that includes weaning of opioid use in the preoperative period and close opioid monitoring postoperatively.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
阿片类药物常用于脊柱手术患者的术前疼痛管理。本研究的目的是评估术前使用阿片类药物是否预示着脊柱手术患者自我报告的预后更差。
本前瞻性队列研究纳入了583例接受腰椎、胸腰椎或颈椎手术以治疗结构性病变的患者。在术前访视时获取患者自我报告的术前阿片类药物消费数据，并将其转换为相应的每日吗啡当量。术后3个月和12个月通过12项简短健康调查问卷和欧洲五维健康量表进行患者报告结局评估，并在适当情况下使用奥斯威斯功能障碍指数和颈部功能障碍指数进行评估。然后进行单独的多变量线性回归分析。
在术前评估中，583例患者中有56%（326例）报告有一定程度的阿片类药物使用。在对年龄、性别、糖尿病、吸烟、手术侵袭性、翻修手术、术前改良躯体感觉问卷评分、术前zung抑郁量表评分和基线结局评分进行多变量分析后发现，术前阿片类药物使用量增加是术后3个月和12个月12项简短健康调查问卷和欧洲五维健康量表评分降低以及奥斯威斯功能障碍指数和颈部功能障碍指数评分增加的显著预测因素（p<0.05）。术前每日吗啡当量每增加10毫克，术后12个月12项简短健康调查问卷身体成分总结和精神成分总结评分降低0.03，欧洲五维健康量表评分降低0.01，奥斯威斯功能障碍指数和颈部功能障碍指数评分增加0.5。术前改良躯体感觉问卷和zung抑郁量表评分较高也是显著的负性预测因素（p<0.05）。
脊柱手术前阿片类药物消费量增加、改良躯体感觉问卷评分和zung抑郁量表评分预示着患者报告的预后更差。这表明采用多学科方法进行心理和阿片类药物筛查具有潜在益处，该方法包括术前停用阿片类药物以及术后密切监测阿片类药物使用情况。
预后II级。有关证据水平的完整描述，请参阅作者指南。
