Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA.
Spine (Phila Pa 1976). 2020 Jul 15;45(14):968-975. doi: 10.1097/BRS.0000000000003511.
Retrospective study.
The aim of this study was to determine risk factors for prolonged opioid use and to investigate whether opioid-tolerance affects patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) surgery.
There is a lack of consensus on risk factors that can affect continued opioid use after cervical spine surgery and the influence of opioid use on patient-reported outcomes.
Ninety-two patients who underwent ACDF for degenerative cervical pathologies were retrospectively identified and their opioid usage before surgery was investigated using a state-sponsored prescription drug monitoring registry. Opioid-naïve and opioid tolerant groups were defined using criteria most consistent with the Federal Drug Administration (FDA) definition. Patient-reported outcomes were then collected, including the Short Form-12 (SF-12) Physical Component (PCS-12) and Mental Component (MCS-12), the Neck Disability Index (NDI), the Visual Analogue Scale Neck (VAS neck) and the Visual Analogue Scale Arm (VAS Arm) pain scores. Logistic regression was used to determine predictors for prolonged opioid use following ACDF. Univariate and multivariate analyses were conducted to compare change in outcomes over time between the two groups.
Logistic regression analysis demonstrated that opioid tolerance was a significant predictor for prolonged opioid use after ACDF (odds ratio [OR]: 18.2 [1.46, 226.4], P = 0.02). Duration of usage was also found to be a significant predictor for continued opioid use after surgery (OR: 1.10 [1.0, 1.03], P = 0.03). No other risk factors were found to be significant predictors. Both groups overall experienced improvements in patient-reported outcomes after surgery. Multiple linear regression analysis, controlling for patient demographics, demonstrated that opioid-tolerant user status positively affected change in outcomes over time for NDI (β = -13.7 [-21.8,-5.55], P = 0.002) and PCS-12 (β = 6.99 [2.59, 11.4], P = 0.003) but no other outcomes measured.
Opioid tolerance was found to be a significant predictor for prolonged opioid use after ACDF. Additionally, opioid-naïve and opioid-tolerant users experienced overall improvements across PROMs following ACDF. Opioid-tolerance was associated with NDI and PCS-12 improvements over time compared to opioid-naïve users.
回顾性研究。
本研究旨在确定延长使用阿片类药物的风险因素，并探讨阿片类药物耐受是否会影响颈椎前路椎间盘切除融合术（ACDF）后的患者报告结局。
目前对于影响颈椎手术后继续使用阿片类药物的风险因素以及阿片类药物使用对患者报告结局的影响尚无共识。
回顾性确定了 92 例因退行性颈椎病变而行 ACDF 的患者，并使用州政府赞助的处方药物监测登记处调查了他们术前的阿片类药物使用情况。根据与美国食品和药物管理局（FDA）定义最一致的标准，定义阿片类药物耐受和阿片类药物未耐受组。然后收集患者报告的结局，包括简明健康调查问卷 12 项（SF-12）生理成分（PCS-12）和心理成分（MCS-12）、颈椎残障指数（NDI）、颈部视觉模拟量表（VAS 颈部）和手臂视觉模拟量表（VAS 手臂）疼痛评分。使用逻辑回归确定 ACDF 后延长阿片类药物使用的预测因素。进行单变量和多变量分析，以比较两组之间随时间变化的结局变化。
逻辑回归分析表明，阿片类药物耐受是 ACDF 后延长阿片类药物使用的显著预测因素（比值比 [OR]：18.2 [1.46，226.4]，P=0.02）。使用时间也被发现是手术后继续使用阿片类药物的显著预测因素（OR：1.10 [1.0，1.03]，P=0.03）。没有发现其他风险因素是显著的预测因素。两组患者在手术后的患者报告结局均有所改善。控制患者人口统计学特征的多元线性回归分析表明，阿片类药物耐受使用者状态对 NDI（β=-13.7[-21.8，-5.55]，P=0.002）和 PCS-12（β=6.99[2.59，11.4]，P=0.003）的随时间变化的结局有积极影响，但对其他测量的结局没有影响。
阿片类药物耐受被发现是 ACDF 后延长阿片类药物使用的显著预测因素。此外，阿片类药物未耐受和耐受使用者在 ACDF 后在所有 PROM 方面均有总体改善。与阿片类药物未耐受使用者相比，阿片类药物耐受使用者在 NDI 和 PCS-12 方面随时间改善。
4。
