Ahn Junyoung, Bohl Daniel D, Tabaraee Ehsan, Aboushaala Khaled, Elboghdady Islam M, Singh Kern
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
J Neurosurg Spine. 2016 Jan;24(1):206-14. doi: 10.3171/2015.3.SPINE141300. Epub 2015 Sep 11.
Little is known about the accuracy of reporting of preoperative narcotic utilization in spinal surgery. As such, the purpose of this study is to compare postoperative narcotic consumption between preoperative narcotic utilizers who do and do not accurately self-report preoperative utilization.
Patients who underwent anterior cervical discectomy and fusion, minimally invasive lumbar discectomy, or minimally invasive transforaminal lumbar interbody fusion procedures between 2013 and 2014 were prospectively identified. The accuracy of self-reporting preoperative narcotic consumption was determined utilizing the Illinois Prescription Monitoring Program. Total inpatient narcotic consumption during postoperative Days 0 and 1 was compared according to the demographics and preoperative narcotic reporting accuracy. Similarly, the proportion of patients who continued to be dependent on narcotic medications at each postoperative visit was compared according to the demographics and preoperative narcotic reporting accuracy.
A total of 195 patients met the inclusion criteria. Of these, 25% did not use narcotics preoperatively, while 47% and 28% did do so with accurate and inaccurate reporting, respectively. Patients who used narcotics preoperatively were more likely to demonstrate elevated inpatient narcotic consumption (adjusted RR 5.3; 95% CI 1.4-20.1; p = 0.013). However, such patients were no more or less likely to be dependent on narcotic medications at the first (p = 0.618) or second (p = 0.798) postoperative visit. Among patients who used narcotics preoperatively, no differences were demonstrated in terms of inpatient narcotic consumption (p = 0.182) or narcotic dependence following the first (p = 0.982) or second (p = 0.866) postoperative visit according to the self-reported accuracy of preoperative narcotic utilization. The only preoperative factors that were independently associated with elevated inpatient narcotic consumption were workers' compensation status and procedure type. The only preoperative factors that were independently associated with narcotic dependence at the first postoperative visit were female sex, workers' compensation status, and procedure type. The only preoperative factor that was independently associated with narcotic dependence at the second postoperative visit was procedure type.
The findings suggest that determining the actual preoperative narcotic utilization in patients who undergo spine surgery may help optimize postoperative pain management. Approximately 75% of patients used narcotics preoperatively. Patients who used narcotics preoperatively demonstrated significantly higher inpatient narcotic consumption, but this difference did not persist following discharge. Finally, postoperative narcotic consumption (inpatient and following discharge) was independent of the self-reported accuracy of preoperative narcotic utilization. Taken together, these findings suggest that corroboration between the patient's self-reported preoperative narcotic utilization and other sources of information (e.g., family members and narcotic registries) may be clinically valuable with respect to minimizing narcotic requirements, thereby potentially improving the management of postoperative pain.
关于脊柱手术术前麻醉药物使用报告的准确性，目前了解甚少。因此，本研究的目的是比较术前准确和不准确自我报告麻醉药物使用情况的患者术后麻醉药物消耗量。
前瞻性确定2013年至2014年间接受颈椎前路椎间盘切除融合术、微创腰椎间盘切除术或微创经椎间孔腰椎椎体间融合术的患者。利用伊利诺伊州处方监测计划确定术前麻醉药物使用自我报告的准确性。根据人口统计学和术前麻醉药物报告准确性，比较术后第0天和第1天的住院期间麻醉药物总消耗量。同样，根据人口统计学和术前麻醉药物报告准确性，比较每次术后随访时继续依赖麻醉药物的患者比例。
共有195例患者符合纳入标准。其中，25%的患者术前未使用麻醉药物，而分别有47%和28%的患者术前使用了麻醉药物，报告准确和不准确。术前使用麻醉药物的患者更有可能出现住院期间麻醉药物消耗量增加（调整后的相对风险5.3；95%可信区间1.4 - 20.1；p = 0.013）。然而，这些患者在术后第一次（p = 0.618）或第二次（p = 0.798）随访时依赖麻醉药物的可能性并无差异。在术前使用麻醉药物的患者中，根据术前麻醉药物使用自我报告准确性，在住院期间麻醉药物消耗量（p = 0.182）或术后第一次（p = 0.982）或第二次（p = 0.866）随访后的麻醉药物依赖方面，未发现差异。与住院期间麻醉药物消耗量增加独立相关的唯一术前因素是工伤赔偿状况和手术类型。与术后第一次随访时麻醉药物依赖独立相关的唯一术前因素是女性、工伤赔偿状况和手术类型。与术后第二次随访时麻醉药物依赖独立相关的唯一术前因素是手术类型。
研究结果表明，确定接受脊柱手术患者术前实际麻醉药物使用情况可能有助于优化术后疼痛管理。约75%的患者术前使用了麻醉药物。术前使用麻醉药物的患者住院期间麻醉药物消耗量显著更高，但出院后这种差异并未持续。最后，术后麻醉药物消耗量（住院期间和出院后）与术前麻醉药物使用自我报告的准确性无关。综上所述，这些研究结果表明，患者术前麻醉药物使用的自我报告与其他信息来源（如家庭成员和麻醉药物登记处）之间的相互印证，对于尽量减少麻醉药物需求可能具有临床价值，从而有可能改善术后疼痛管理。
