Opioid use prior to spine surgery was not associated with more complications

In the study, 55% of patients used opioids preoperatively. The 30-day complication rate was 7.7%.

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 rates of 30-day and 90-day postoperative 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, a PGY-4 resident in the Department of Orthopaedic Surgery and Rehabilitation at Vanderbilt University Medical Center, in Nashville, Tenn., said.

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

Half of patients used opioids

Overall, the investigators found an average length of stay of 3.16 days and that 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%. Surgical complications requiring oral antibiotics and deep surgical infections requiring irrigation and debridement made up 21% and 16%, respectively, of all complications.

Sheyan J.
Armaghani

“It is important to note that we did not retrospectively see any minor medical complications” which would have had transient detrimental effects, Armaghani said.

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

Depression and length of stay

In addition, the investigators found that in these patients depression was associated with an increased length of hospital stay.

“Interestingly, out of the 55% of our patients who were using preoperative opioids, 79% of them were considered depressed as defined by the Zung Depression Scale. This may be due to the fact that patients with depression are self-medicating themselves with their opioids,” Armaghani said.

He added, “Patients with signs of depression preoperatively are also likely slower to start rehabilitation and mobilization following surgery from a fear of movement.” – by Gina Brockenbrough, MA

Reference:

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

For more information:

Sheyan J. Armaghani, MD, can be reached at Vanderbilt School of Medicine, 215 Light Hall, Nashville, TN 37232; email: sheyan.armaghani@vanderbilt.edu.
Disclosure: Armaghani has no relevant financial disclosures.