190. Preoperative opioid therapy poorly controls pain in nonrevision adult spinal deformity (ASD) and increases risk for chronic postoperative opioid usage

Abstract

BACKGROUND CONTEXT Iatrogenic malalignment, nonunion and adjacent segment degeneration are established etiologies for pain in adult spinal deformity (ASD). However, reasons for pain among ASD patients with no prior history of surgery (nonrevision) are incompletely understood. Opioid therapy for pain is controversial and problematic. PURPOSE Compare pain scores in nonrevision ASD patients who preoperatively receive opioids vs no opioids and evaluate pain scores and risk for chronic opioid use following surgical treatment. It is hypothesized that preop opioid therapy poorly controls pain and increases risk for chronic postop opioid use compared to opioid nonusers in nonrevision ASD patients. STUDY DESIGN/SETTING Analysis of a prospective multicenter ASD database. PATIENT SAMPLE ASD patients with no history of prior spine surgery, enrolled into a prospective multicenter database and subsequently surgically treated for ASD. OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), SF-36, numeric rating scale (NRS) back and leg pain. METHODS ASD patients (age >18 years, no history of spine surgery), were enrolled into a prospective multicenter ASD database and evaluated for opioid use on SRS-22r questionnaire. Patients divided into preop opioid (OPIOID) vs nonopioid (NON) users, organized into SRS deformity types (thoracic, lumbar, double, sagittal and mixed), treated surgically for ASD and evaluated minimum 2 years postop. Pre- and postop demographic, radiographic, and pain values evaluated, and postop opioid usage compared. RESULTS Two hundred twenty-seven of 426 patients, (mean follow-up 3.3 years) were eligible for study and evaluated. Distribution of SRS deformity type for OPIOID vs NON was similar. Comparison of scoliosis patients (thoracic, lumbar or double deformities) demonstrated OPIOID (n=32) had similar preop age, BMI, smoking history, maximal scoliosis, SVA, and sagittal spinopelvic parameters as NON (n=95; p>0.05). However, OPIOID had greater preop NRS back pain (7.3 vs 6.1), leg pain (4.9 vs 3.1), and worse SF-36 bodily pain (31.8 vs 39.8) than NON (p 0.05). However, OPIOID had greater preop NRS back pain (7.8 vs 7.0), leg pain (5.8 vs. 3.8), and worse SF-36 bodily pain (29.3 vs. 35.6) than NON (p CONCLUSIONS Evaluation of 227 surgically treated nonrevision ASD patients demonstrated that despite having similar demographics, spinal deformity and similar surgery OPIOID reported greater preop pain scores, greater postop pain scores and had greater risk for opioid usage than NON. The relative risk of opioid usage at 2 years postop was 5.0 for preop daily users and 2.8 for preop weekly users compared to NON. Preop opioid therapy should be avoided in non-revision ASD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.