Schoenfeld Andrew J, Nwosu Kenneth, Jiang Wei, Yau Allan L, Chaudhary Muhammad Ali, Scully Rebecca E, Koehlmoos Tracey, Kang James D, Haider Adil H
1Department of Orthopaedic Surgery (A.J.S., K.N., and J.D.K.), Department of Surgery (W.J., M.A.C., R.E.S., and A.H.H.), and Center for Surgery and Public Health (A.J.S., W.J., M.A.C., R.E.S., and A.H.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 2Tufts University School of Medicine, Boston, Massachusetts 3Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
J Bone Joint Surg Am. 2017 Aug 2;99(15):1247-1252. doi: 10.2106/JBJS.16.01075.
There is a growing concern that the use of prescription opioids following surgical interventions, including spine surgery, may predispose patients to chronic opioid use and abuse. We sought to estimate the proportion of patients using opioids up to 1 year after discharge following common spinal surgical procedures and to identify factors associated with sustained opioid use.
This study utilized 2006 to 2014 data from TRICARE insurance claims obtained from the Military Health System Data Repository. Adults who underwent 1 of 4 common spinal surgical procedures (discectomy, decompression, lumbar posterolateral arthrodesis, or lumbar interbody arthrodesis) were identified. Patients with a history of opioid use in the 6 months preceding surgery were excluded. Posterolateral arthrodesis and interbody arthrodesis were considered procedures of high intensity, and discectomy and decompression, low intensity. Covariates included demographic factors, preoperative diagnoses, comorbidities, postoperative complications, and mental health disorders. Risk-adjusted Cox proportional hazard models were used to evaluate the time to opioid discontinuation.
This study included 9,991 patients. Eighty-four percent filled at least 1 opioid prescription on discharge. At 30 days following discharge, 8% continued opioid use; at 3 months, 1% continued use; and at 6 months, 0.1%. In the adjusted analysis, the low-intensity surgical procedures were associated with a higher likelihood of discontinuing opioid use (discectomy: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.36 to 1.50; and decompression: HR = 1.34, 95% CI = 1.25 to 1.43). Depression (HR = 0.84, 95% CI = 0.77 to 0.90) was significantly associated with a decreased likelihood of discontinuing opioid use (p < 0.001).
By 6 months following discharge, nearly all patients had discontinued opioid use after spine surgery. As only 0.1% of the patients continued opioid use at 6 months following surgery, these results indicate that spine surgery among opioid-naive patients is not a major driver of long-term prescription opioid use. Socioeconomic status and pre-existing mental health disorders may be factors associated with sustained opioid use following spine surgery.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
人们越来越担心在包括脊柱手术在内的外科手术后使用处方阿片类药物可能会使患者易于长期使用和滥用阿片类药物。我们试图估计在常见脊柱外科手术后出院长达1年使用阿片类药物的患者比例，并确定与持续使用阿片类药物相关的因素。
本研究利用了从军事卫生系统数据存储库获得的2006年至2014年TRICARE保险索赔数据。确定了接受4种常见脊柱外科手术之一（椎间盘切除术、减压术、腰椎后外侧融合术或腰椎椎间融合术）的成年人。排除术前6个月有阿片类药物使用史的患者。后外侧融合术和椎间融合术被视为高强度手术，椎间盘切除术和减压术为低强度手术。协变量包括人口统计学因素、术前诊断、合并症、术后并发症和精神障碍。使用风险调整的Cox比例风险模型评估停用阿片类药物的时间。
本研究纳入9991例患者。84%的患者在出院时至少开具了1张阿片类药物处方。出院后30天，8%的患者继续使用阿片类药物；3个月时，1%的患者继续使用；6个月时，0.1%的患者继续使用。在调整分析中，低强度外科手术与停用阿片类药物的可能性较高相关（椎间盘切除术：风险比[HR]=1.43，95%置信区间[CI]=1.36至1.50；减压术：HR=1.34，95%CI=1.25至1.43）。抑郁症（HR=0.84，95%CI=0.77至0.90）与停用阿片类药物的可能性降低显著相关（p<0.001）。
出院后6个月时，几乎所有脊柱手术后的患者都已停用阿片类药物。由于术后6个月只有0.1%的患者继续使用阿片类药物，这些结果表明，在未使用过阿片类药物的患者中，脊柱手术并非长期处方阿片类药物使用的主要驱动因素。社会经济地位和既往精神障碍可能是脊柱手术后持续使用阿片类药物的相关因素。
治疗性III级。有关证据水平的完整描述，请参阅作者须知。
