Whitfield Savannah Rose, Hanson Andrew Charles, Bellamkonda Erica, Garza Maria Mendoza De La, Schmidt Xander, Hooten William Michael, Warner Nafisseh Sirjani
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Asian Spine J. 2025 Aug;19(4):590-599. doi: 10.31616/asj.2024.0414. Epub 2025 May 30.
A retrospective cohort study.
To evaluate the association between preoperative opioid use and discharge disposition following major spine surgery and between discharge disposition and opioid availability through 1 year postoperatively.
Preoperative opioid use is prevalent in spine surgery and is associated with larger postoperative opioid consumption, longer hospitalizations, increased healthcare expenses, and greater risk of surgical revision. However, whether preoperative opioid use is associated with discharge disposition following major spine surgery, which may serve as an indicator of postoperative functional recovery, remains unclear.
This retrospective population-based cohort study incorporated comprehensive prescription opioid information for 2223 adults (age ≥18 years) undergoing spine surgery in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2016. Multivariable models were employed to assess the relationships among preoperative opioid exposures, postoperative opioid exposures, and discharge disposition (home, inpatient rehabilitation facility [IRF], and skilled nursing facility [SNF]).
A total of 2,223 adults were included with the following preoperative opioid availability: none (778 [35.0%]), short term (1,118 [50.3%]), episodic (227 [10.2%]), and long term (100 [4.5%]). Discharge dispositions were home (1,984 [89.2%]), IRF (94 [4.2%]), and SNF (145 [6.5%]). Compared with patients with no preoperative opioid availability, those with short-term or episodic opioid availability are less likely to be discharged to an IRF (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.36-0.87; p=0.010). Patients with long-term opioid availability had significantly increased odds of SNF discharge (OR, 2.93; 95% CI, 1.39-6.17; p=0.005). At 1-year follow-up, patients discharged to IRF had an increased likelihood of long-term postoperative opioid availability compared with those discharged home (OR, 12.49; 95% CI, 4.84-32.24; p<0.001).
Preoperative opioid prescribing was associated with post-hospitalization discharge disposition, which in turn was associated with opioid prescribing patterns 1 year postoperatively. Assessing opioid prescribing trends preoperatively may guide discussions regarding anticipated discharge disposition following spine surgery.
一项回顾性队列研究。
评估脊柱大手术后术前阿片类药物使用与出院处置之间的关联，以及出院处置与术后1年阿片类药物可获得性之间的关联。
术前使用阿片类药物在脊柱手术中很普遍，并且与术后更大的阿片类药物消耗量、更长的住院时间、更高的医疗费用以及更高的手术翻修风险相关。然而，术前使用阿片类药物是否与脊柱大手术后的出院处置相关，而出院处置可能作为术后功能恢复的一个指标，目前尚不清楚。
这项基于人群的回顾性队列研究纳入了2005年1月1日至2016年12月31日期间在明尼苏达州奥尔姆斯特德县接受脊柱手术的2223名成年人（年龄≥18岁）的全面处方阿片类药物信息。采用多变量模型评估术前阿片类药物暴露、术后阿片类药物暴露和出院处置（回家、住院康复机构[IRF]和熟练护理机构[SNF]）之间的关系。
总共纳入了2223名成年人，其术前阿片类药物可获得性情况如下：无（778人[35.0%]）、短期（1118人[50.3%]）、偶发（227人[10.2%]）和长期（100人[4
