Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
World Neurosurg. 2019 Aug;128:e231-e237. doi: 10.1016/j.wneu.2019.04.107. Epub 2019 Apr 19.
The widespread over-use of narcotics has been increasing. However, whether narcotic use impacts surgical outcomes after complex spinal fusion remains understudied. The aim of this study was to evaluate whether there is an association between preoperative narcotic use with perioperative complication rates, patient-reported pain scores, and ambulatory status after complex spinal fusions.
The medical records of 134 adult (age ≥18 years) patients with spinal deformity undergoing elective, primary complex spinal fusion (≥5 levels) for deformity correction in a major academic institution from 2005-2015 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative complication rates, pain scores, and ambulatory status were collected for each patient.
Patient demographics and comorbidities were similar between both cohorts, except that the Narcotic-User cohort had a greater mean age (57.5 years vs. 50.7 years; P = 0.045) and prevalence of depression (39.4% vs. 16.2%; P = 0.003). Complication rates were similar between both cohorts. The Narcotic-User cohort had significantly higher pain scores at baseline (6.7 ± 2.4 vs. 4.0 ± 3.4; P < 0.001) and at the first postoperative pain score reported (6.7 ± 2.8 vs. 5.3 ± 2.9; P = 0.013), but had a significantly greater improvement from baseline to last pain score (Narcotic-User: -2.5 ± 3.9 vs. Non-User: -0.5 ± 4.7; P = 0.031). The Narcotic-User cohort had significantly greater ambulation on the first postoperative ambulatory day compared with the Non-User cohort (103.8 ± 144.4 vs. 56.4 ± 84.0; P = 0.031).
Our study suggests that the preoperative use of narcotics may impact patient perception of pain and improvement after complex spinal fusions (≥5 levels). Consideration of patients' narcotic status preoperatively may facilitate tailored pain management and physical therapy regimens.
阿片类药物的广泛过度使用一直在增加。然而，复杂脊柱融合术后使用阿片类药物是否会影响手术结果仍研究不足。本研究旨在评估术前使用阿片类药物与围手术期并发症发生率、患者报告的疼痛评分以及复杂脊柱融合术后的活动能力之间是否存在关联。
回顾了 2005 年至 2015 年期间在一家主要学术机构接受择期、原发性复杂脊柱融合术（≥5 个节段）治疗脊柱畸形的 134 名成年（年龄≥18 岁）患者的病历。收集每位患者的患者人口统计学、合并症、围手术期并发症发生率、疼痛评分和活动能力。
两组患者的人口统计学和合并症相似，但阿片类药物使用者组的平均年龄（57.5 岁 vs. 50.7 岁；P=0.045）和抑郁患病率（39.4% vs. 16.2%；P=0.003）更高。两组的并发症发生率相似。阿片类药物使用者组的基线疼痛评分（6.7±2.4 分 vs. 4.0±3.4 分；P<0.001）和首次术后疼痛评分（6.7±2.8 分 vs. 5.3±2.9 分；P=0.013）更高，但从基线到最后一次疼痛评分的改善幅度更大（阿片类药物使用者：-2.5±3.9 分 vs. 非使用者：-0.5±4.7 分；P=0.031）。与非使用者组相比，阿片类药物使用者组在术后首次活动日的活动能力明显更高（103.8±144.4 分 vs. 56.4±84.0 分；P=0.031）。
我们的研究表明，术前使用阿片类药物可能会影响复杂脊柱融合术后（≥5 个节段）患者对疼痛的感知和改善。术前考虑患者的阿片类药物使用情况可能有助于制定个性化的疼痛管理和物理治疗方案。
