Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 268. Narcotic use trends in elective thoracolumbar spinal surgery patients

Abstract

BACKGROUND CONTEXT Narcotic use has increased rapidly in the US in recent years. There is an association between preoperative narcotic use and increased length of stay, inadequate perioperative pain control and poor spine surgery outcomes. PURPOSE To investigate patterns of narcotic use in Canadian spine surgery patients, examine trends over time, and determine the effect of spine surgery on postoperative narcotic use. STUDY DESIGN/SETTING Multicentre, ambispective review of consecutive thoracolumbar spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network (CSORN) between October 2008 and August 2017. METHODS Retrospective analysis of prospectively-collected data on elective thoracolumbar surgery patients in the CSORN database. Self-reported narcotic use at baseline, presurgery and 1-year postoperative were compared. Baseline narcotic use by age, gender and presenting complaint was also compared. All patients meeting eligibility criteria from database inception to 2017 were included. RESULTS A total of 3,134 patients met inclusion criteria and provided baseline data on narcotic use. Over time (<2014 to 2017), there was no statistically significant change in the proportion of patients taking narcotics on a daily (range: 32.3%–38.2%) or intermittent (range: 13.7%–22.5%) basis. There was no difference in the frequency of narcotic use at baseline and presurgery in patients who waited longer than six weeks for surgery. There were significantly more patients using narcotics with a chief complaint of back pain or radiculopathy than neurogenic claudication (p<.001), and who were younger (<65 years old) than older (p<.001). At 1-year postoperatively, daily narcotic use decreased significantly from baseline (34.5% to 16.9% (p<.01)). CONCLUSIONS Narcotic use in spine surgery patients in Canada is widespread. Although narcotic use might decrease postoperatively, as surgeons we are having little to no impact on our patients’ narcotic use while on the waitlist for surgery. An opportunity may exist to intervene in this critical preoperative stage to optimize surgical outcomes. Continued efforts to decrease narcotic use should be focused on <65 years old radiculopathy and back pain patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Narcotic use has increased rapidly in the US in recent years. There is an association between preoperative narcotic use and increased length of stay, inadequate perioperative pain control and poor spine surgery outcomes. To investigate patterns of narcotic use in Canadian spine surgery patients, examine trends over time, and determine the effect of spine surgery on postoperative narcotic use. Multicentre, ambispective review of consecutive thoracolumbar spine surgery patients enrolled by the Canadian Spine Outcomes and Research Network (CSORN) between October 2008 and August 2017. Retrospective analysis of prospectively-collected data on elective thoracolumbar surgery patients in the CSORN database. Self-reported narcotic use at baseline, presurgery and 1-year postoperative were compared. Baseline narcotic use by age, gender and presenting complaint was also compared. All patients meeting eligibility criteria from database inception to 2017 were included. A total of 3,134 patients met inclusion criteria and provided baseline data on narcotic use. Over time (<2014 to 2017), there was no statistically significant change in the proportion of patients taking narcotics on a daily (range: 32.3%–38.2%) or intermittent (range: 13.7%–22.5%) basis. There was no difference in the frequency of narcotic use at baseline and presurgery in patients who waited longer than six weeks for surgery. There were significantly more patients using narcotics with a chief complaint of back pain or radiculopathy than neurogenic claudication (p<.001), and who were younger (<65 years old) than older (p<.001). At 1-year postoperatively, daily narcotic use decreased significantly from baseline (34.5% to 16.9% (p<.01)). Narcotic use in spine surgery patients in Canada is widespread. Although narcotic use might decrease postoperatively, as surgeons we are having little to no impact on our patients’ narcotic use while on the waitlist for surgery. An opportunity may exist to intervene in this critical preoperative stage to optimize surgical outcomes. Continued efforts to decrease narcotic use should be focused on <65 years old radiculopathy and back pain patients.