Do Daily Use of Opioids Post Spinal Surgery Have Severe Side-Effects?

People who use narcotics daily on average after surgery for spinal deformities can have worse outcomes, according to a new study. The side effects include longer intensive care unit stays and more severe postop disability. The findings of the study are published in the journal Spine.

"We're not suggesting that people facing ASD surgery stop taking opioids on the basis of this study, but we do think it's worthwhile having more conversations with physicians to see if there are alternatives or ways of reducing opioid use before surgery," says Micheal Raad, M.D., orthopaedic surgery research fellow at the Johns Hopkins University School of Medicine and the paper's senior author.

Spinal Cord Injury - Causes, Symptoms, Diagnosis, Treatment & Prevention
Spinal cord injury is an injury to the spinal cord that results in temporary or permanent changes in its function.

‘Daily narcotic users can turn old faster and have a higher prevalence of depression than nondaily users.’

Tweet it Now

The proportion of patients with adult spinal deformity (ASD), a disorder that encompasses most forms of adult scoliosis, who use opioids for pain control has been shown to be as high as 70 percent.

While previous studies have shown that preoperative narcotic use is linked with poor outcomes for other elective orthopaedic surgeries, spinal fusions and total knee arthroplasties , none examined the effects on ASD patients specifically, say the scientists.

To understand how outcomes such as length of stay and severity of disability were affected by preoperative daily opioid use for this subset of patients, the research team identified 475 eligible patients from 18 surgical centers across the country who had undergone surgery for ASD between January 2008 and March 2015.

World Spine Day � Remain Active For A Healthy Spine
World Spine Day, observed annually on the 16th October hopes to raise awareness about the importance of a healthy back in order to lead a more productive life.

Patients' self-reported narcotic use was categorized as either daily or nondaily, and other patient data -- such as baseline health characteristics and outcomes -- were collected preoperatively and at six weeks, one year and two years postoperatively.

The average age of the patients was 58 years and 79 percent (334 of 425) were women.

Bone Marrow Edema Occurs Mostly in the Joints of Lower Spine
Young athletes develop bone marrow edema (BME) in their sacroiliac joints. BME damage is most frequently seen in the posterior lower ilium or the lowest part of the spine.

Of the patients included in the study, 44 percent self-reported daily presurgery narcotic use. Daily narcotic users were older (average age of 62 years versus 54 years for nondaily users) and had a higher prevalence of depression (37 percent) than nondaily users (14 percent).

Daily narcotic users had more comorbidities, more severe back pain and greater disability, as measured by various clinical scales. Daily users had 70 percent higher odds for a prolonged length of hospital stay, an average of 16 hours longer stay in the intensive care unit and 690 percent higher odds of using narcotics daily two years after the operation.

First Robotic Device for Treating Spine Deformities Developed
Development of a new Robotic Spine Exoskeleton (RoSE) device measures 3-D stiffness of human torso, which can lead to the development of new treatments for children with spine deformities.

While the authors acknowledge study limitations such as the unreliability of self-reported drug use, the inability to definitively point to daily narcotic use as the cause of poorer outcomes and the lack of information on patients' specific opioid prescriptions, they say the findings generally improve clinicians' understanding of narcotic use in ASD patients and how surgical outcomes may be affected.

With an increasingly aging U.S. population, surgery for ASD is expected to rise sharply over the upcoming decade, and given the substantial levels of pain and disability this patient population is subject to, daily narcotic use is widespread, say the scientists.

"We hope that this information serves as a foundation for future research into the prevalence of daily narcotic use in this patient group and provides clinicians with a framework for patient risk stratification and preoperative counseling," adds Khaled Kebaish, M.D., F.R.C.S.C., professor of orthopaedic surgery at the Johns Hopkins University School of Medicine and the paper's lead author.

Source-Eurekalert