Hah Jennifer M, Levine Shana C, Khairnar Saneel, Pirrotta Luke, Ben-Natan Alma Rechav, Tse Emily, Hettie Gabrielle, Alamin Todd, Veeravagu Anand, Hu Serena, Hernandez-Boussard Tina
Department of Anesthesiology, Perioperative, and Pain Medicine; Stanford University School of Medicine, Stanford, CA, USA.
University of California, Irvine, School of Medicine, Irvine, CA, USA.
Neurospine. 2025 Jun;22(2):451-464. doi: 10.14245/ns.2550394.197. Epub 2025 Jun 30.
Preoperative opioid misuse is associated with worse postoperative outcomes. This prospective longitudinal cohort study evaluated the association between preoperative opioid misuse and prolonged pain and opioid use after elective spine surgery; and examined postoperative trajectories of patient-reported outcomes over one year.
Fifty-two patients undergoing elective spine surgery completed presurgical and weekly postoperative longitudinal assessments of pain and opioid use and monthly assessments of depression, anxiety, sleep disturbance, and physical function. Cox regression analyzed the effect of preoperative opioid misuse on time to pain and opioid cessation while linear mixed-effects models examined longitudinal changes in postoperative outcomes.
Adjusting for age, sex, operative region, number of spinal levels, and any preoperative opioid use, preoperative opioid misuse (COMM-Positive) was associated with a delayed return to baseline opioid dose (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14-0.88; p=0.02) and delayed opioid cessation (HR, 0.25; 95% CI, 0.09-0.59; p=0.008). All patients experienced comparable reductions in current and average pain intensity, and pain interference over time. COMM-Positive patients reported a normalization of postoperative anxiety and depression 1 month after surgery with a rebound at 3 months while patients without preoperative opioid misuse remained stable over time.
Preoperative opioid misuse is a significant risk factor for delayed opioid cessation even after adjusting for preoperative opioid use, and is associated with a transient normalization of anxiety and depressive symptoms with a rebound 3 months following spine surgery. Targeted screening and risk reduction strategies are needed for patients reporting preoperative opioid misuse before spine surgery.
术前阿片类药物滥用与更差的术后结局相关。这项前瞻性纵向队列研究评估了术前阿片类药物滥用与择期脊柱手术后疼痛延长和阿片类药物使用之间的关联；并检查了患者报告结局在一年中的术后轨迹。
52例接受择期脊柱手术的患者完成了术前和术后每周一次的疼痛和阿片类药物使用纵向评估，以及每月一次的抑郁、焦虑、睡眠障碍和身体功能评估。Cox回归分析术前阿片类药物滥用对疼痛缓解和阿片类药物停用时间的影响，而线性混合效应模型检查术后结局的纵向变化。
在调整年龄、性别、手术区域、脊柱节段数量和任何术前阿片类药物使用情况后，术前阿片类药物滥用（COMM阳性）与恢复至基线阿片类药物剂量延迟（风险比[HR]，0.35；95%置信区间[CI]，0.14 - 0.88；p = 0.02）和阿片类药物停用延迟（HR，0.25；95% CI，0.09 - 0.59；p = 0.008）相关。所有患者的当前和平均疼痛强度以及疼痛干扰随时间均有类似程度的降低。COMM阳性患者术后1个月报告焦虑和抑郁恢复正常，3个月时出现反弹，而术前无阿片类药物滥用的患者随时间保持稳定。
即使在调整术前阿片类药物使用情况后，术前阿片类药物滥用仍是阿片类药物停用延迟的重要危险因素，并且与脊柱手术后3个月焦虑和抑郁症状短暂恢复正常并反弹有关。对于脊柱手术前报告有术前阿片类药物滥用的患者，需要有针对性的筛查和风险降低策略。
