How does preoperative opioid use impact postoperative health-related quality of life scores for patients undergoing lumbar microdiscectomy?

Abstract

Background ContextNarcotic use amongst patients suffering from lumbar radiculopathy is common, but the clinical benefit of narcotics for lumbar radiculopathy is likely minimal. It is unknown what the impact of preoperative use of narcotics has on outcomes related to lumbar microdiscectomy. PurposeDetermine the impact that preoperative opioid use has on postoperative outcomes after lumbar microdisectomy. Study DesignRetrospective analysis of a prospectively collected database. Patient SampleOne hundred and twenty-six patients undergoing a microdiscectomy for a lumbar disc herniation. Outcome MeasuresPatient-reported outcomes measurement information system mental health scores (PROMIS MHS), patient-reported outcomes measurement information system physical health scores (PROMIS PHS) and oswestry disability index (ODI). MethodsWe analyzed a prospectively collected database of patients undergoing a lumbar microdiscectomy for preoperative opioid use. We measured the severity of lumbar pathology on MRI based on degree of facet/disc degeneration and cross-sectional area of the dural tube at the disc herniation. We tracked PROMIS MHS, PROMIS PHS and ODI for patients both preoperatively and postoperatively. A Mann-Whitney test was used to compare HRQOL scores and time to MCID for the opioid using cohort (OC) and the nonopioid using cohort (non-OC). We performed a linear regression analysis to determine correlation between preoperative opioid use and postoperative HRQOLs. ResultsThere were 44 of 126 microdiscectomy patients in the OC (32.5%). There was no difference in the dural cross-sectional area (p=.91), degree of facet degeneration (p=.38), or disc degeneration (p=.5) between OC and non-OC. There were no differences in PROMIS PHS, PROMIS MHS or ODI between the OC and non-OC at the preoperative visit and all postoperative time points. There were no differences in time to reach MCID between the OC and non-OC for ODI (p=.9), PROMIS PHS (p=.64) or PROMIS MHS (p=.90). At three months out from surgery there was a statistically significant correlation between pre-op opioid use and ODI (p=.02), PROMIS MHS (p=.02) and PROMIS PHS (p=.049). ConclusionsOur results demonstrate that patients that use opioids prior to lumbar microdiscectomy have equivalent postoperative outcomes as those that do not use opioids. Use of higher doses of opioids is associated with worse short-term outcomes.