Zhou Zeyi, Jin Michael C, Jensen Michael R, Guinle Maria Isabel Barros, Ren Alexander, Agarwal Ank A, Leaston Joshua, Ratliff John K
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
World Neurosurg. 2023 May;173:e180-e188. doi: 10.1016/j.wneu.2023.02.029. Epub 2023 Feb 11.
To assess opioid usage in surgical and nonsurgical patients with lumbar disc herniation receiving different treatments and timing of treatments.
Individuals with newly diagnosed lumbar intervertebral disc herniation without myelopathy were queried from a health claims database. Patients were categorized into 3 cohorts: nonsurgical, early surgery, and late surgery. Early surgery cohort patients underwent surgery within 30 days postdiagnosis; late surgery cohort patients had surgery after 30 days but before 1 year postdiagnosis. The index date was defined as the diagnosis date for nonsurgical patients and the initial surgery date for surgical patients. The primary outcome was the average daily opioid morphine milligram equivalents (MME) prescribed. Additional outcomes included percentage of opioid-using patients and cumulative opioid burden.
Inclusion criteria were met by 573,082 patients: 533,226 patients received nonsurgical treatments, 22,312 patients received early surgery, and 17,544 patients received late surgery. Both surgical cohorts experienced a postsurgical increase in opioid usage, which then sharply declined and gradually plateaued, with daily opioid MME consistently lower in the early versus late surgery cohort. The early surgery cohort also consistently had a lower prevalence of opioid-using patients than the late surgery cohort. Patients receiving nonsurgical treatment demonstrated the highest 1-year post index cumulative opioid burden, and the early surgery cohort consistently had lower cumulative opioid MME than the late surgery cohort.
Early surgery in patients with lumbar disc herniation is associated with lower long-term average daily MME, incidence of opioid use, and 1-year cumulative MME burden compared with nonsurgical and late surgery treatment approaches.
评估接受不同治疗方法及治疗时机的腰椎间盘突出症手术和非手术患者的阿片类药物使用情况。
从健康保险理赔数据库中查询新诊断为无脊髓病的腰椎间盘突出症患者。患者分为3组：非手术组、早期手术组和晚期手术组。早期手术组患者在诊断后30天内接受手术；晚期手术组患者在诊断后30天但在1年内接受手术。索引日期定义为非手术患者的诊断日期和手术患者的初次手术日期。主要结局是每日开具的阿片类药物吗啡毫克当量（MME）的平均值。其他结局包括使用阿片类药物患者的百分比和累积阿片类药物负担。
573,082例患者符合纳入标准：533,226例患者接受非手术治疗，22,312例患者接受早期手术，17,544例患者接受晚期手术。两个手术组术后阿片类药物使用量均增加，随后急剧下降并逐渐趋于平稳，早期手术组的每日阿片类药物MME始终低于晚期手术组。早期手术组使用阿片类药物患者的患病率也始终低于晚期手术组。接受非手术治疗的患者在索引日期后1年的累积阿片类药物负担最高，早期手术组的累积阿片类药物MME始终低于晚期手术组。
与非手术和晚期手术治疗方法相比，腰椎间盘突出症患者早期手术的长期平均每日MME、阿片类药物使用发生率和1年累积MME负担较低。
