Pritzker School of Medicine of the University of Chicago, Chicago, Illinois.
Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois.
Spine (Phila Pa 1976). 2018 Dec 15;43(24):1739-1745. doi: 10.1097/BRS.0000000000002714.
Retrospective cohort utilizing the National Inpatient Sample (NIS) 2003 to 2014.
To investigate the association of opioid dependence with prolonged length of stay (LOS), costs, and surgical complications in elective one-to-two level lumbar fusion.
Opioids are the most commonly prescribed drug class to treat back pain. Few studies have examined the impact of opioid dependence on spinal fusion outcomes. The data available show inconsistent conclusions regarding the association between opioid dependence and LOS.
Data from 1,826,868 adult elective one-to-two level lumbar fusion discharges in the NIS from 2003 to 2014 were included. Discharges were categorized into an opioid-dependent or unaffected cohort based on the presence or absence of an International Classification of Disease, Ninth Revision-Clinical Modification (ICD-9-CM) code for opioid dependence. Incidence of opioid dependence was compared between 2003 and 2014 via adjusted Wald tests. Patient and surgical characteristics, costs, and complications were compared between cohorts via chi-square tests or adjusted Wald tests for categorical and continuous variables, respectively. Patient and surgical factors were tested for association with prolonged LOS via univariable logistic regressions, and significant (P ≤ 0.01) factors were included in a multivariable logistic regression.
Seven thousand nine hundred sixty-four (0.44%) discharges included a diagnosis of opioid dependence. The incidence of opioid dependence increased from 2003 to 2014. Opioid dependence was associated with an adjusted 2.11 times higher odds of prolonged LOS. Opioid-dependent discharges accrued higher costs and had higher frequencies of infection, device-related complications, hematoma- or seroma-related complications, acute posthemorrhagic anemia, and pulmonary insufficiency.
This nationally-representative study suggests that opioid dependence is associated with prolonged LOS in lumbar fusion, as well as higher costs and higher frequencies of surgical complications. Further investigations are needed to determine the optimal method to treat opioid-dependent patients who require lumbar fusion.
回顾性队列研究，利用国家住院患者样本（NIS）2003 年至 2014 年的数据。
探讨阿片类药物依赖与择期单-双节段腰椎融合术患者住院时间延长、费用增加和手术并发症之间的关系。
阿片类药物是治疗背痛最常用的药物类别。很少有研究探讨阿片类药物依赖对脊柱融合术结果的影响。现有数据显示，阿片类药物依赖与住院时间延长之间的关系存在不一致的结论。
纳入 2003 年至 2014 年 NIS 中 1826868 例择期单-双节段腰椎融合术成年患者的数据。根据是否存在阿片类药物依赖的国际疾病分类，第九修订版临床修正（ICD-9-CM）代码，将出院患者分为阿片类药物依赖组或未受影响组。通过调整 Wald 检验比较 2003 年和 2014 年阿片类药物依赖的发生率。通过卡方检验或调整 Wald 检验分别比较两组患者和手术特征、费用和并发症，对分类和连续变量进行比较。通过单变量逻辑回归分析患者和手术因素与住院时间延长的关系，选择 P≤0.01 的有意义因素纳入多变量逻辑回归分析。
7964 例（0.44%）出院诊断为阿片类药物依赖。阿片类药物依赖的发生率从 2003 年到 2014 年有所增加。阿片类药物依赖与住院时间延长的调整后比值比增加了 2.11 倍。阿片类药物依赖患者的住院费用更高，且感染、器械相关并发症、血肿或血清肿相关并发症、急性出血后贫血和肺功能不全的发生率更高。
这项全国代表性研究表明，阿片类药物依赖与腰椎融合术后住院时间延长以及费用增加和手术并发症发生率增加有关。需要进一步研究以确定治疗需要腰椎融合术的阿片类药物依赖患者的最佳方法。
3 级
