Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02214, USA.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Spine J. 2019 Oct;19(10):1666-1671. doi: 10.1016/j.spinee.2019.05.001. Epub 2019 May 9.
The opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort.
We sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts.
STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals.
Sustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery.
The performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use.
Among 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0-53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1-4.2) in the low-risk group (scores <30), 17.2% (15.6-18.7) in the intermediate-risk group (scores 30-60), and 46.0% (36.2-55.9) in the high-risk group (scores >60).
We have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.
阿片类药物泛滥促使人们对医疗实践和手术等增加阿片类药物依赖风险的医疗事件进行更严格的审查。此前，在接受普通外科、骨科和泌尿科手术的患者人群中，开发了用于预测持续处方类阿片药物使用的 STOPPING Opioids after SURGERY（SOS）评分。值得注意的是，该评分在脊柱外科患者队列中的表现尚未得到评估。
我们旨在通过对接受颈椎和腰椎手术的一系列患者（包括住院和门诊患者）进行验证，评估该 SOS 评分在脊柱外科中的应用。
研究设计/地点：在两家学术医疗中心和三家社区医院进行回顾性研究。
术后持续使用处方类阿片药物定义为术后 90 天或以上持续使用阿片类药物处方。
通过计算 C 统计量、接受者操作特征曲线和观察到的持续使用处方类阿片药物的发生率，评估 SOS 评分在研究人群中的表现。
在纳入的 7027 例患者中，2374 例（33.8%）接受了前路颈椎间盘切除术和融合术，4653 例（66.2%）接受了腰椎间盘突出症手术。中位年龄为 46 岁（四分位距=38.0-53.5）。总体而言，604 例患者（8.6%）存在长期阿片类药物处方。风险评分的 C 统计量为 0.764。评分低值截断点（30 分）的灵敏度为 0.72。评分高值截断点（60 分）的特异性为 0.99。低风险组（评分<30 分）的长期阿片类药物处方的观察风险（95%置信区间）为 3.6%（3.1-4.2），中风险组（评分 30-60 分）为 17.2%（15.6-18.7），高风险组（评分>60 分）为 46.0%（36.2-55.9）。
我们验证了一种临床相关的床边风险评分用于预测脊柱手术后持续使用处方类阿片药物的应用。该评分易于使用，性能卓越，是脊柱护理提供者在为患者提供咨询和确定适当的出院后管理以预防持续使用阿片类药物方面的有价值的工具。
