66. Preop opioid use is associated with worse postop outcomes and chronic opioid use in nonrevision adult scoliosis patients: corroboration of two independent multicenter studies

Abstract

BACKGROUND CONTEXT Sagittal malalignment and failed surgery are established etiologies for pain in adult spinal deformity (ASD). However, pain in primary adult scoliosis with good sagittal alignment is poorly understood. Opioids may be administered to control pain in adult scoliosis but are controversial and may negatively impact patient outcome. Evaluation of two independent ASD datasets may reduce bias and help understand the impact of preop opioid therapy on postop outcomes. PURPOSE Compare datasets from two independent ASD studies to evaluate the impact that the presence and frequency of opioid use has upon postop outcomes in adult scoliosis patients who have no prior history of spine surgery and no sagittal malalignment. STUDY DESIGN/SETTING Comparative analysis of datasets from two prospective multicenter ASD studies. PATIENT SAMPLE ASD patients with no history of prior spine surgery and no sagittal malalignment (as defined by the Scoliosis Research Society ASD Classification) enrolled into two independent multicenter databases and subsequently surgically treated for adult scoliosis OUTCOME MEASURES Scoliosis Research Society-22r questionnaire (SRS-22r), SF-36 and SF-12 Physical Component Score (PCS) and Mental Component Score (MCS), numeric rating scale (NRS) back and leg pain METHODS Adult scoliosis patients age >18 years, no history of spine surgery, and presence of thoracic, lumbar or double scoliosis (as per SRS deformity type) were identified from 2 independent prospective databases and assessed for preop non-opioid (NON) vs opioid use and amount of use (DAILY vs WEEKLY). Mixed and sagittal deformities were eliminated to reduce confounding pain impact of sagittal malalignment. Patients were treated surgically and pre- and postop demographic, radiographic data, patient-reported outcome measures and postop opioid usage were evaluated, minimum 2-year follow-up. RESULTS Database 1 (D1; 102/102 patients; mean follow up 2.1+0.2yr) and Database 2 (D2; 116/168 patients, mean follow-up 3.3 years) demonstrated similar preop demographic, depression history, smoking history and radiographic parameters for NON, DAILY and WEEKLY (p>0.05; Table). DAILY had greater preop NRS back and leg pain, and worse preop PCS and MCS than NON (p 0.05). At last follow-up, DAILY had worse postop NRS back pain (D1=4.1, D2=4.9), worse PCS (D1=38.8, D2=41.9), and worse MCS (D1=49.7, D2=45.4) than NON and WEEKLY (p CONCLUSIONS Comparison of datasets from two independent, multicenter prospective ASD studies demonstrated dataset agreement that preop opioid use and increased frequency of preop opioid use in adult scoliosis patients with no history of prior surgery and no sagittal malalignment is associated with worse postop pain, outcomes and continued opioid use. Attempts should be made, including program development, to aid in the discontinuation of preop and postop opioid usage for adult scoliosis to help improve postop outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.