TY - JOUR
T1 - Does preoperative narcotic use adversely affect outcomes and complications after spinal deformity surgery? A comparison of nonnarcotic- with narcotic-using groups
AU - Mesfin, Addisu
AU - Lenke, Lawrence G.
AU - Bridwell, Keith H.
AU - Akhtar, Usman
AU - Jupitz, Jennifer M.
AU - Fogelson, Jeremy L.
AU - Hershman, Stuart H.
AU - Kim, Han J.
AU - Koester, Linda A.
N1 - Funding Information:
Author disclosures: AM: Fellowship Support: AOSpine (E, Paid directly to institution). LGL: Royalties: Medtronic (I), Quality Medical Publishing (B); Speaking/Teaching Arrangements: DePuy Synthes (C [donated to private foundation]), K2M (C [donated to private foundation]); Trips/Travel: AMCICO, AOSpine, BroadWater, COA, DePuy Synthes, Dubai Spine Society, Medtronic, SOSORT, SRS, SSF, The Spinal Research Foundation (E, total for all listed [reimbursement only]); Board of Directors: SRS (unpaid position); Research Support (Investigator Salary, Staff/Materials): John and Marcella Fox Foundation Research Project to support staff salary of Clinical Nurse Coordinator of project (G); Grants: Axial Biotech, DePuy Synthes Spine (B); Fellowship Support: AOSpine North America (C). KHB: Grant: NIH grant (H >5 years [2010–2015], Paid directly to institution); Fellowship Support: OREF (E, Paid directly to institution). UA: Nothing to disclose. JMJ: Nothing to disclose. JLF: Nothing to disclose. SHH: Nothing to disclose. HJK: Speaking/Teaching Arrangements: K2M (B); Scientific Advisory Board/Other Office: Spine Innovation Advisory Board—Medtronic, Inc. (B); Fellowship Support: AOSpine (E, Paid directly to institution). LAK: Nothing to disclose.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Background context The role of preoperative (preop) narcotic use and its influence on outcomes after spinal deformity surgery are unknown. It is important to determine which patient factors and comorbidities can affect the success of spinal deformity surgery, a challenging surgery with high rates of complications at baseline.Study design/setting Retrospective evaluation of prospectively collected data.Patient sample Two hundred fifty-three adult patients (230 females/23 males) undergoing primary spinal deformity surgery were enrolled from 2000 to 2009.Outcome measures Preoperative and postoperative (postop) narcotic use and changes in Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) pain, and SRS total scores.Methods Preoperative, 2-year postop, and latest follow-up pain medication use were collected along with ODI, SRS pain, and SRS scores. Preoperative insurance status, surgical and hospitalization demographics, and complications were collected. All patients had a minimum 2-year follow-up (average 47.4 months).Results One hundred sixty-eight nonnarcotic (NoNarc) patients were taking no pain meds or only nonsteroidal anti-inflammatories preoperatively. Eighty-five patients were taking mild/moderate/heavy narcotics before surgery. The average age was 48.2 years for the NoNarc group versus 53.6 years for the Narc group (p<.005). There were significantly more patients with degenerative than adult scoliosis in the Narc group (47 vs. 28, p<.001; mild 19 vs. 24, p<.02; moderate 6 vs. 14, p<.0003; heavy 3 vs. 10, p<.0002). Insurance status (private/Medicare/Medicaid) was similar between the groups (p=.39). At latest follow-up, 137/156 (88%) prior NoNarc patients were still not taking narcotics whereas 48/79 (61%) prior narcotic patients were now off narcotics (p<.001). Significant postop improvements were seen in Narc versus NoNarc groups with regard to ODI (26-15 vs. 44-30.3, p<.001), SRS pain (3.36-3.9 vs. 2.3-3.38, p<.001), and overall SRS outcome (3.36-4 vs. 2.78-3.68, p<.001) scores. A comparison of change in outcome scores between the two groups showed a higher improvement in SRS pain scores for the Narc versus NoNarc group (p<.001).Conclusions In adults with degenerative scoliosis taking narcotics a significant decrease in pain medication use was noted after surgery. All outcome scores significantly improved postop in both groups. However, the Narc group had significantly greater improvements in SRS pain scores versus the NoNarc group.
AB - Background context The role of preoperative (preop) narcotic use and its influence on outcomes after spinal deformity surgery are unknown. It is important to determine which patient factors and comorbidities can affect the success of spinal deformity surgery, a challenging surgery with high rates of complications at baseline.Study design/setting Retrospective evaluation of prospectively collected data.Patient sample Two hundred fifty-three adult patients (230 females/23 males) undergoing primary spinal deformity surgery were enrolled from 2000 to 2009.Outcome measures Preoperative and postoperative (postop) narcotic use and changes in Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) pain, and SRS total scores.Methods Preoperative, 2-year postop, and latest follow-up pain medication use were collected along with ODI, SRS pain, and SRS scores. Preoperative insurance status, surgical and hospitalization demographics, and complications were collected. All patients had a minimum 2-year follow-up (average 47.4 months).Results One hundred sixty-eight nonnarcotic (NoNarc) patients were taking no pain meds or only nonsteroidal anti-inflammatories preoperatively. Eighty-five patients were taking mild/moderate/heavy narcotics before surgery. The average age was 48.2 years for the NoNarc group versus 53.6 years for the Narc group (p<.005). There were significantly more patients with degenerative than adult scoliosis in the Narc group (47 vs. 28, p<.001; mild 19 vs. 24, p<.02; moderate 6 vs. 14, p<.0003; heavy 3 vs. 10, p<.0002). Insurance status (private/Medicare/Medicaid) was similar between the groups (p=.39). At latest follow-up, 137/156 (88%) prior NoNarc patients were still not taking narcotics whereas 48/79 (61%) prior narcotic patients were now off narcotics (p<.001). Significant postop improvements were seen in Narc versus NoNarc groups with regard to ODI (26-15 vs. 44-30.3, p<.001), SRS pain (3.36-3.9 vs. 2.3-3.38, p<.001), and overall SRS outcome (3.36-4 vs. 2.78-3.68, p<.001) scores. A comparison of change in outcome scores between the two groups showed a higher improvement in SRS pain scores for the Narc versus NoNarc group (p<.001).Conclusions In adults with degenerative scoliosis taking narcotics a significant decrease in pain medication use was noted after surgery. All outcome scores significantly improved postop in both groups. However, the Narc group had significantly greater improvements in SRS pain scores versus the NoNarc group.
KW - Adults
KW - Degenerative scoliosis
KW - Narcotic use
KW - ODI
KW - Outcomes
KW - Spinal deformity
UR - http://www.scopus.com/inward/record.url?scp=84919327642&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2014.03.049
DO - 10.1016/j.spinee.2014.03.049
M3 - Article
C2 - 24704676
AN - SCOPUS:84919327642
SN - 1529-9430
VL - 14
SP - 2819
EP - 2825
JO - Spine Journal
JF - Spine Journal
IS - 12
ER -