Shen Thomas, Wick Joseph B, Patel Bobby, Kong Shana, Bakr Oussama, Wick Katherine D, Mitra Hari, Khoo Kendrick, Javidan Yashar, Roberto Rolando F, Klineberg Eric O, Le Hai V
From the Department of Orthopedic Surgery, University of California, Davis, CA (Shen, J.B. Wick, Patel, Kong, Bakr, Mitra, Khoo, Javidan, Roberto, Klineberg, and Le), and the Department of Medicine, University of California, San Francisco, CA (K.D. Wick).
J Am Acad Orthop Surg. 2023 Feb 1;31(3):e157-e168. doi: 10.5435/JAAOS-D-22-00513. Epub 2022 Oct 7.
Opioid overuse is a substantial cause of morbidity and mortality in the United States, and orthopaedic surgeons are the third highest prescribers of opioids. Postoperative prescribing patterns vary widely, and there is a paucity of data evaluating patient and surgical factors associated with discharge opioid prescribing patterns after elective anterior cervical surgery (ACS). The purpose of this study was to evaluate the volume of postoperative opioids prescribed and factors associated with discharge opioid prescription volumes after elective ACS.
We retrospectively identified patients aged 18 years and older who underwent elective primary anterior cervical diskectomy and fusion (ACDF), cervical disk arthroplasty (CDA), or hybrid procedure (ACDF and CDA at separate levels) at a single institution between 2015 and 2021. Demographic, surgical, and opioid prescription data were obtained from patients' electronic medical records. Univariate and multivariate analyses were conducted to assess for independent associations with discharge opioid volumes.
A total of 313 patients met inclusion criteria, including 226 (72.2%) ACDF, 69 (22.0%) CDA, and 18 (5.8%) hybrid procedure patients. Indications included radiculopathy in 63.6%, myelopathy in 19.2%, and myeloradiculopathy in 16.3%. The average age was 57.2 years, and 50.2% of patients were male. Of these, 88 (28.1%) underwent one-level, 137 (43.8%) underwent two-level, 83 (26.5%) underwent three-level, and 5 (1.6%) underwent four-level surgery. Younger age (P = 0.010), preoperative radiculopathy (P = 0.029), procedure type (ACDF, P < 0.001), preoperative opioid use (P = 0.012), and discharge prescription written by a midlevel provider (P = 0.010) were independently associated with greater discharge opioid prescription volumes.
We identified wide variability in prescription opioid discharge volumes after ACS and patient, procedure, and perioperative factors associated with greater discharge opioid volumes. These factors should be considered when designing protocols and interventions to reduce and optimize postoperative opioid use after ACS.
阿片类药物过度使用是美国发病和死亡的一个重要原因，骨科医生是阿片类药物的第三大处方者。术后处方模式差异很大，且缺乏评估与择期颈椎前路手术（ACS）后出院阿片类药物处方模式相关的患者和手术因素的数据。本研究的目的是评估择期ACS后开具的术后阿片类药物数量以及与出院阿片类药物处方量相关的因素。
我们回顾性地确定了2015年至2021年期间在单一机构接受择期原发性颈椎前路椎间盘切除术和融合术（ACDF）、颈椎间盘置换术（CDA）或混合手术（不同节段的ACDF和CDA）的18岁及以上患者。从患者的电子病历中获取人口统计学、手术和阿片类药物处方数据。进行单因素和多因素分析以评估与出院阿片类药物量的独立关联。
共有313例患者符合纳入标准，包括226例（72.2%）ACDF患者、69例（22.0%）CDA患者和18例（5.8%）混合手术患者。适应证包括神经根病63.6%、脊髓病19.2%和脊髓神经根病16.3%。平均年龄为57.2岁，50.2%的患者为男性。其中，88例（28.1%）接受了单节段手术，137例（43.8%）接受了双节段手术，83例（26.5%）接受了三节段手术，5例（1.6%）接受了四节段手术。年龄较小（P = 0.010）、术前神经根病（P = 0.029）、手术类型（ACDF，P < 0.001）、术前使用阿片类药物（P = 0.012）以及由中级医疗人员开具出院处方（P = 0.010）与出院阿片类药物处方量较大独立相关。
我们发现ACS后处方阿片类药物出院量存在很大差异，以及与出院阿片类药物量较大相关的患者、手术和围手术期因素。在设计减少和优化ACS后术后阿片类药物使用的方案和干预措施时，应考虑这些因素。
