Sharma Neena K, Olotu Busuyi, Mathew Asha, Waitman Lemuel R, Rasu Rafia
University of Kansas Medical Center, Kansas City, KS, USA.
West Coast University, Los Angeles, CA, USA.
Hosp Pharm. 2017 Dec;52(11):774-780. doi: 10.1177/0018578717737431. Epub 2017 Nov 9.
Pain after spine surgery is usually managed with opioid and nonopioids. The rate of lumbar spine surgeries (LSS) is rising, but current practices on LSS are not known. A current trend in LSS and medication usage by age group is needed to gain a better understanding of how LSS and its pain management vary by age. The aim of this study was to report current practices of LSS of discectomy, laminectomy, and fusion in patients aged 18 and older and to gain an understanding of medication use for management of LSS. This retrospective study analyzed data of the University of Kansas Medical Center from 2007 to 2014 of patients (>18 years of age) undergoing laminectomy, discectomy, and fusion. A total of 19 463 patients underwent LSS between 2007 and 2014 at Kansas University hospital. For the purpose of this study, 3115 patients' medical records were observed. A 50% increase in LSS between 2007 and 2014 was noted. Specifically, more than 2-fold increase in LSS was observed in patients aged 65 years and older. Among those aged 65 years and older, laminectomy was the most commonly performed surgery (69.6%) while discectomy was the most common surgery performed among those aged 18 to 34 (82.9%) and those aged 35 to 44 (72%). The medication use also increased with a highest usage in opioids alone (55%), followed by opioids combined with other analgesics (42.7%), regardless of lumbar surgery type or age. The information of increase in both LSS and the medication usage over the 7 years can be used to gain a better understanding of quality, expenditure, and outcomes following LSS. This knowledge may help health care providers plan patient care and rehabilitation services for older adults, as the trajectory of lumbar spine surgery is likely to rise with growing prevalence of older adults. The information regarding increased opioid utilization may also help clinicians to refine opioid usage and consider alternative approaches to manage acute postoperative pain, in light of the current concerns related to overutilization of opioids.
脊柱手术后的疼痛通常采用阿片类药物和非阿片类药物进行处理。腰椎手术（LSS）的发生率正在上升，但目前关于LSS的治疗方法尚不清楚。需要了解LSS和按年龄组划分的药物使用的当前趋势，以便更好地理解LSS及其疼痛管理如何随年龄而变化。本研究的目的是报告18岁及以上患者椎间盘切除术、椎板切除术和融合术的LSS当前治疗方法，并了解用于LSS管理的药物使用情况。这项回顾性研究分析了堪萨斯大学医学中心2007年至2014年期间接受椎板切除术、椎间盘切除术和融合术的患者（年龄>18岁）的数据。2007年至2014年期间，共有19463名患者在堪萨斯大学医院接受了LSS。为了本研究的目的，观察了3115名患者的病历。2007年至2014年期间，LSS增加了50%。具体而言，65岁及以上患者的LSS增加了两倍多。在65岁及以上的患者中，椎板切除术是最常进行的手术（69.6%），而椎间盘切除术是18至34岁（82.9%）和35至44岁（72%）患者中最常进行的手术。无论腰椎手术类型或年龄如何，药物使用也有所增加，单独使用阿片类药物的使用率最高（55%），其次是阿片类药物与其他镇痛药联合使用（42.7%）。7年来LSS和药物使用增加的信息可用于更好地理解LSS后的质量、支出和结果。随着老年人患病率的上升，腰椎手术的趋势可能会增加，这些知识可能有助于医疗保健提供者为老年人规划患者护理和康复服务。鉴于目前对阿片类药物过度使用的担忧，有关阿片类药物使用增加的信息也可能有助于临床医生优化阿片类药物的使用，并考虑采用替代方法来管理急性术后疼痛。
