Risk Factors Associated with Prolonged Postoperative Opioids Use in Non-Cancer Patients Undergoing Spinal Surgery: A Retrospective Study

Authors

  • Arpawan Thepsuwan Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Sasikaan Nimmaanrat Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Paramee Thongsuksai Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110

DOI:

https://doi.org/10.31584/jhsmr.2022869

Keywords:

non-cancer patients, postoperative opioid, prolonged opioids use, risk factors, spinal surgery

Abstract

Objective: To identify risk factors associated with prolonged postoperative opioids use in non-cancer patients undergoing spinal surgery.
Material and Methods: The medical records of patients, who underwent spinal surgery at Songklanagarind Hospital; from January 2014 to January 2019, were retrospectively reviewed, Data analysis was performed using multinomial logistic regression to identify independent factors associated with prolonged postoperative opioids use.
Results: There were 65 out of 500 patients (13.0%) who had prolonged postoperative opioids usage. Opioids used before surgery as well as length of hospital stay after surgery were risk factors associated with prolonged postoperative opioids use (relative risk (RR), 47.65; 95% CI, 17.67-128.49 and RR, 1.07; 95% CI, 1.01-1.14, respectively). Whereas, preoperative gabapentinoids use reduced the risk of prolonged postoperative opioids use (RR, 0.33; 95% CI, 0.13-0.83).
Conclusion: Avoiding preoperative opioids used, by using gabapentinoids instead could reduce the risk associated with prolonged postoperative opioids use; in addition to related morbidity and mortality in non-cancer spinal pain patients.

References

Busse JW, Wang L, Kamaleldin M, Craigie S, Riva JJ, Montoya L, et al. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA 2018;320:2448–60.

Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med 2007;146:116-27.

Jirarattanaphochi K, Jung S. Nonsteroidal anti-inflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials. J Neuro spine SPI 2019;9:22-31.

Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med 2011;171:686–91.

Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality and after elective orthopedic surgery. Clin Orthop Relat Res 2015; 473:2402–12.

Solomon DH, Rassen JA, Glynn RJ, Garneau K, Levin R, Lee J, et al. The comparative safetyof opioids for nonmalignant pain in older adults. Arch Intern Med 2010;170:1979-86.

Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Trends in opioid use and dosing among socio-economically disadvantaged patients. Open Med 2011;5:e13–22.

Boudreau D, VonKorff M, Rutter CM, Saunders K, Ray GT, Sullivan MD, et al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf 2009;18:1166-75.

Schoenfeld AJ, Nwosu K, Jiang W, Yau AL, Chaudhary MA, Scully RE, et al. Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am 2017;99:1247–52.

Pugely AJ, Bedard NA, Kalakoti P, Hendrickson NR, Shillingford JN, Laratta JL, et al. Opioid use following cervical spine surgery: trends and factors associated with long-term use. Spine J 2018;18:1974-81.

Dunn LK, Yerra S, Fang S, Hanak MF, Leibowitz MK, Tsang S. Incidence and risk factors for chronic postoperative opioid use after major spine surgery: a cross-sectional study with longitudinal outcome. Anesth Analg 201;127:247–54.

Soneji N, Clarke HA, Ko DT, Wijeysundera DN. Risks of developing persistent opioid use after major surgery. JAMA Surg 2016;151:1083–4.

Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014;348:1251.

Yang S, Werner BC. Risk factors for prolonged postoperative opioid use after spinal fusion for adolescent idiopathic scoliosis. J Ped Orthop 2019;39:500–4.

Connolly J, Javed Z, Raji MA, Chan W, Kuo YF, Baillargeon J. Predictors of long-term opioid use following lumbar fusion surgery. Spine 2017;42:1405–11.

Adogwa O, Davison MA, Vuong VD, Desai SA, Lilly DT, Moreno J, et al. Regional variation in opioid use after lumbar spine surgery. World Neurosurg 2019;121:e691-9.

Rosenthal BD, Suleiman LI, Kannan A, Edelstein AI, Hsu WK, Patel AA. Risk factors for prolonged postoperative opioid use after spine surgery: a review of dispensation trends from a state-run prescription monitoring program. J Am Acad Orthop Surg 2019;27:32-38.

Markman JD, Kress BT, Frazer M, Hanson R, Kogan V, Huang JH. Screening for neuropathic characteristics in failed back surgery syndromes: challenges for guiding treatment. Pain Med 2015;16:520-30.

Verret M, Lauzier F, Zarychanski R, Perron C, Savard X, Pinard AM, et al. Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta-analysis. Anesthesiology 2020;133:265-79.

Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among children and adolescents: a nationwide, cohort-based questionnaire survey in Finland. Spine 1997;22:1132–6.

Balague F, Troussier B, Salminen JJ. Non-specific low back pain in children and adolescents: risk factors. Eur Spine J 1999,8:429–38.

Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The adult spine: principles and practice. Philadelphia: Lippincott-Raven; 1997;p.93–141.

Singleton MA, Rosen JI, Fisher DM. Pharmacokinetics of fentanyl in the elderly. Br J Anaesth 1988;60:619–22. 24. Richardson J, Bresland K. The management of postsurgical pain in the elderly population. Drugs Aging 1998;13:17–31.

Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers’ compensation setting. Spine 2015;40:1775–84.

Downloads

Published

2023-04-08

How to Cite

1.
Thepsuwan A, Nimmaanrat S, Thongsuksai P. Risk Factors Associated with Prolonged Postoperative Opioids Use in Non-Cancer Patients Undergoing Spinal Surgery: A Retrospective Study. J Health Sci Med Res [Internet]. 2023 Apr. 8 [cited 2024 Dec. 23];40(5):571-84. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/262748

Issue

Section

Original Article