38. Opioid use prior to adult spine deformity (ASD) surgery worsens postoperative outcomes and risks continued postoperative use, independent of spine deformity magnitude and type of surgery performed: a propensity matched cohort analysis

Abstract

BACKGROUND CONTEXT Opioid use prior to spine deformity surgery may compromise postoperative outcomes. However, patient comorbidities, deformity magnitude, and type of surgery performed are also associated with patient outcomes for ASD. An analysis to control for confounding variables including patient demographics and type of surgery performed may provide greater understanding of the impact that preoperative opioid use has on surgically treated ASD patients. PURPOSE Isolate the impact of preoperative opioid use on baseline and postoperative outcomes for ASD by performing a propensity score matched (PSM) analysis to control for confounding patient demographic, spine deformity, and surgical variables. STUDY DESIGN/SETTING Propensity score matched (PSM) analysis of operatively treated ASD patients from a prospective multicenter database. PATIENT SAMPLE ASD patients, age >18 years, no history of spine surgery prior to study enrollment, ≥4 levels fused at the time of surgery after study enrollment, and minimum 2 years of postoperative follow-up. OUTCOME MEASURES Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), duration of hospital stay, duration of ICU stay. METHODS ASD patients (age >18 years) enrolled into a prospective multicenter ASD database were divided into preoperative opioid (OPIOID) vs nonopioid (NON) users. Propensity score matching (PSM) was used to control for patient age, medical comorbidities, deformity magnitude, and type of surgery performed. Pre- and postoperative patient-reported outcome measures, duration of ICU and hospital stay, perioperative complications, and continued opioid use at one and two years postoperative was evaluated. RESULTS Of 358 eligible patients, 262 were evaluated (mean follow-up=3.5 years). OPIOID (n=98) and NON (n=164) had similar preoperative age, deformity type and magnitude, BMI, smoking history, ASA grade, comorbidity burden, history of smoking and depression, levels fused at surgery, fusion to the pelvis, and 3 column osteotomy (p>0.05). Preoperatively, OPIOID had greater NRS back pain (7.7 vs 6.8) and leg pain (2.5 vs 2.3), worse ODI (50.8 vs 36.9), worse SF-36 PCS (37.3 vs 47.0), and worse SRS-22r self-image (2.0 vs 2.8) than NON, respectively (p 0.05). CONCLUSIONS Propensity score matched analysis of operatively treated ASD patients demonstrated patients using opioids preoperatively have greater baseline and 2-year postoperative disability compared to opioid nonusers, independent of patient demographics, deformity magnitude, and type of surgery performed. Over 50% of preoperative opioid users reported continued postoperative opioid use at one year postoperative, and over 40% had continued use at two years postoperative, compared to 18% and 12% usage at one and two years postoperatively for preoperative nonusers. Attempts should be made to eliminate opioid consumption prior to ASD surgery to improve patient outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.