Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Spine (Phila Pa 1976). 2019 Jul 1;44(13):E800-E807. doi: 10.1097/BRS.0000000000002965.
STUDY DESIGN: Retrospective analysis. OBJECTIVE: To investigate sex differences in opioid use after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. SUMMARY OF BACKGROUND DATA: Recent studies have demonstrated higher prevalence of chronic pain states and greater pain sensitivity among women compared with men. Furthermore, differences in responsivity to pharmacological and non-pharmacological treatments have been observed. Whether sex differences in perioperative opioid use exists in patients undergoing lumbar fusion for symptomatic stenosis or spondylolisthesis remains unknown. METHODS: An insurance database, including private/commercially insured and Medicare Advantage beneficiaries, was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index 1,2, or 3-level index lumbar decompression and fusion procedures between 2007 and 2016. Records were searchable by International Classification of diseases diagnosis and procedure codes, and generic drug codes specific to Humana. Opioid use 6-months prior to through 2-years after index surgery was assessed. The primary outcome was sex differences in opioid use after index lumbar surgery. The secondary outcome was independent predictors of prolonged opioid use after lumbar fusion. RESULTS: Of the 13,257 participants (females: 7871, 59.8%), 58.4% of women used opioids compared with 56.9% of men prior to index surgery. At 1-year after surgery, continuous opioid use was observed in 67.1% of women compared with 64.2% of men (P < 0.001). Within 2-years postoperatively, opioid use was observed in 83.1% of women versus 82.5% men. In a multivariate logistic regression analysis, female sex (odds ration [OR] 1.14, 95% confidence interval [CI]: 1.058-1.237), obesity (OR 1.10, 95% CI: 1.004-1.212), and preoperative narcotic use (OR 3.43, 95% CI: 3.179-3.708) was independently associated with prolonged (>1 yr) opioid use after index surgery. CONCLUSION: We observed a higher prevalence of chronic opioid use among women following lumbar fusion surgery. Female sex was independently associated with prolonged opioid use after index surgery. LEVEL OF EVIDENCE: 3.
研究设计：回顾性分析。 目的：调查腰椎减压融合术治疗症状性腰椎狭窄或滑脱患者的性别差异与阿片类药物的使用情况。 背景资料总结：最近的研究表明，女性比男性更容易出现慢性疼痛状态和更高的疼痛敏感性。此外，还观察到对药物和非药物治疗的反应存在差异。对于接受腰椎融合术治疗症状性狭窄或滑脱的患者，围手术期阿片类药物使用是否存在性别差异尚不清楚。 方法：使用包括私人/商业保险和医疗保险优势受益人的保险数据库，对 2007 年至 2016 年期间接受 1、2 或 3 级指数腰椎减压和融合手术的有症状腰椎狭窄或滑脱患者进行了索引检索。记录可通过国际疾病诊断分类和程序代码以及 Humana 特定的通用药物代码进行搜索。评估了索引手术前 6 个月至术后 2 年期间的阿片类药物使用情况。主要结果是腰椎手术后性别差异与阿片类药物的使用情况。次要结果是腰椎融合术后延长阿片类药物使用的独立预测因素。 结果：在 13257 名参与者中（女性：7871 名，59.8%），术前女性使用阿片类药物的比例为 58.4%，而男性为 56.9%。手术后 1 年，连续使用阿片类药物的女性为 67.1%，而男性为 64.2%（P<0.001）。术后 2 年内，女性阿片类药物使用率为 83.1%，而男性为 82.5%。多变量逻辑回归分析显示，女性（比值比 [OR] 1.14，95%置信区间 [CI]：1.058-1.237）、肥胖（OR 1.10，95%CI：1.004-1.212）和术前使用麻醉药物（OR 3.43，95%CI：3.179-3.708）是术后索引手术中延长（>1 年）阿片类药物使用的独立相关因素。 结论：我们观察到女性在腰椎融合手术后慢性阿片类药物使用的患病率更高。女性是索引手术后延长阿片类药物使用的独立相关因素。 证据水平：3 级。
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