Opioid use prior to spine surgery not linked with increased postoperative complications

NEW ORLEANS — Findings presented at the North American Spine Society Annual Meeting indicate that increasing preoperative opioid use by patients undergoing elective spine surgery is associated with increased length of hospital stay, but not increased postoperative 30- and 90-day complications.

“Opioids are frequently used by patients prior to elective spine surgery, and increasing preoperative opioid use and depression are actual treatable causes for increased hospital length of stay following spine surgery. Targeting these patients who are predisposed for longer hospital stays with interventions to wean opioids prior to surgery as well as adding psychosocial therapy to those who are likely to have underlying depression can benefit both the patient and the surgeon,” Sheyan J. Armaghani, MD, said.

To assess whether increased amounts of preoperative opioid use is linked with higher postoperative complication rates or length of hospital stay, Armaghani and colleagues used their institution’s prospective registry to identify 580 patients treated for lumbar, thoracolumbar or cervical lesions. Patients self-reported preoperative narcotic use, which investigators converted to daily morphine equivalent amounts.

Overall, the investigators found the average length of stay was 3.16 days and 55% of patients used opioids preoperatively. The study revealed a 30-day complication rate of 7.7% and a 30-day to 90-day complication rate of 1.7%.

Although an analysis of 30-day complications showed current smoking status was associated with increased complications, a 90-day analysis did not show a correlation with any of the studied variables.

“Our length of stay analysis did expectedly show that increasing age as well as increasing surgical invasiveness did increase length of stay,” Armaghani said. “Also, increasing preoperative narcotic use and increasing levels of depression also showed increased length of stay. Preoperative opioid use then was not associated with 30-day or 90-day complications.”

He noted that an increase of 100-morphine equivalence led to a 1.1-day longer hospital stay.

“This may be due to the fact that patients’ pain is more difficult to control, and they have a slower resolution of their pain,” he said.

Reference:

Armaghani S. Paper #153. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans.

Disclosure: Armaghani has no relevant financial disclosures.