Preoperative Opioid Consumption Research Articles

Effectiveness of a Preoperative Bowel Preparation Protocol for Patients With Adolescent Idiopathic Scoliosis to Decrease Postoperative Gastrointestinal Morbidities and the Hospital Length of Stay.

Randomised controlled trial. This study aimed to determine the effectiveness of a preoperative bowel preparation protocol comprising bisacodyl to minimize postoperative gastrointestinal morbidities and the hospital length of stay for patients with adolescent idiopathic scoliosis. Patients who undergo scoliosis correction surgery frequently experience postoperative gastrointestinal morbidities and a prolonged hospital length of stay. Emesis, paralytic ileus and constipation are the most common gastrointestinal morbidities. Opioid medication is a well-known risk factor for gastrointestinal complications after scoliosis correction surgery. Eighty-seven patients (22 boys [25.3%] and 65 girls [74.7%]) with a mean age of 17.7years (standard deviation [SD], ±2.2 years) diagnosed with adolescent idiopathic scoliosis were enrolled in this study and randomized into 2 groups. Group A comprised 44 patients who received a preoperative bowel preparation comprising bisacodyl. Group B comprised 43 patients who did not receive any preoperative medication. Demographic data, height, weight, medical and surgical comorbidities, Risser status, number of instrumented levels and preoperative opioid consumption of all patients were evaluated. Group A experienced fewer postoperative abdominal symptoms than group B. The mean hospital length of stay was 4.1 days (SD, ±.6 days; median, 4days; range, 3-5days) for group A; however, it was 5.3days (SD, ±.8 days; median, 5days; range, 4-7days) for group B (P = .01). The use of a bowel preparation protocol before scoliosis correction surgery for patients with adolescent idiopathic scoliosis can effectively decrease postoperative gastrointestinal morbidities and the hospital length of stay.

Skeletal Traction for Isolated Femur Fractures Does Not Reduce Opioid Consumption.

Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine whether preoperative opioid consumption differs significantly between these forms of treatment. Case-control retrospective study. Two academic Level 1 trauma centers. Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017 to 2020. The primary outcome was preoperative opioid consumption (morphine milligram equivalents) comparing patients treated with application of TXN or placed in a position of COMF. Two hundred and twenty patients were studied (COMF n = 167, TXN n = 53). Multivariate regression analysis revealed significantly greater preoperative opioid consumption in the emergency department for the TXN group compared with COMF (2.6 more morphine milligram equivalents [confidence interval, 0.23-4.96], P = 0.031). There was no difference in preoperative opioid consumption between groups on the hospital floor ( P = 0.811) nor during the entire preoperative course ( P = 0.486). The total preoperative rate of opioid consumption (morphine milligram equivalents/hour) did not differ ( P = 0.825). Patients with isolated femoral shaft fractures treated preoperatively with skeletal traction consumed more opioids in the emergency department compared with patients treated in a position of comfort, but no difference in opioid consumption was observed between groups for the entire preoperative course. A position of comfort may be considered as an acceptable alternative to skeletal traction for patients with isolated femur fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preoperative Alcohol Use, Postoperative Pain, and Opioid Use After Coronary Artery Bypass Surgery

ObjectivesChronic alcohol use is associated with chronic pain and increased opioid consumption. The association between chronic alcohol use and acute postoperative pain has been minimally studied. Our objective was to explore the association between preoperative alcohol use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG). DesignRetrospective cohort study. SettingSingle academic medical center. ParticipantsPatients having isolated CABG. InterventionsNone Measurements and Main ResultsDemographics, comorbidities, and baseline alcohol consumption were recorded. Primary outcomes were mean pain score and morphine milligram equivalent consumption on postoperative day 0. Among 1,338 patients, there were 764 (57.1%) who had no weekly preoperative alcohol use, 294 (22.0%) who drank ≤ 1 drink per week, 170 (12.7%) who drank 2-7 drinks per week, and 110 (8.2%) who drank 8 or more drinks per week. There was no significant difference in mean pain score on postoperative day 0 in patients who consumed different amounts of alcohol (No alcohol = 5.3 ± 2.2, ≤ 1 drink = 5.2 ± 2.1, 2-7 drinks = 5.3 ± 2.3, 8 or more drinks = 5.4 ± 1.9, P=0.66). There was also no significant difference in median MME use on postoperative day 0 in patients who consumed different amounts of alcohol (No alcohol = 22.5 mg, ≤ 1 drink=21.1 mg, 2-7 drinks = 24.8 mg, 8 or more drinks = 24.5 mg, P=0.14). ConclusionsThere is no apparent association between mild to moderate preoperative alcohol consumption and early postoperative pain and opioid use in CABG patients.

Comment on 'Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomised trial'.

Comment on 'Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in emergency patients with hip fracture: a randomised trial'.

Authors' reply to the comment on 'Effect of early ultrasound-guided femoral nerve block on preoperative opioid consumption in patients with hip fracture: a randomized trial'.

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Effect of Preoperative Marijuana on Patient Outcomes and Opioid Use after Lumbar Decompression.

Retrospective Cohort Study. Our study aims to analyze the effect of preoperative marijuana use on outcomes and postoperative opioid use in patients who have undergone lumbar decompression without fusion. All patients >18years of age who underwent lumbar decompression from 2017-2022 with documented preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match incorporating demographics, procedure type, and levels decompressed was performed to compare preoperative marijuana users and non-users. 1-year preoperative and postoperative opioid consumption in milligrams of morphine equivalents and postoperative outcomes including readmissions, reoperations, and complications, were obtained. A multivariate regression model was performed to measure the effect of marijuana use on the likelihood of a spine reoperation. Of the 340 included patients, 85 were preoperative marijuana users. There were no significant differences in medical complications, 90-day readmissions, or opioid consumption preoperatively or postoperatively (P > .05). We identified a trend towards patients who used marijuana having more reoperations for any cause (20.0% vs 11.37%, P = .067). Multivariate logistic regression analysis suggested that preoperative marijuana use was a significant predictor of all-spine reoperations (OR = 2.06, P = .036). In lumbar decompression patients, preoperative marijuana use does not impact opioid consumption, readmissions, or medical complications, but is a significant predictor of future postoperative reoperations. Additional research is necessary to further explore the role of marijuana use in spine surgery.

Post-surgical discharge opioid prescribing, use and handling after introduction of a stewardship program.

SummaryOpioids are often used to provide postsurgical analgesia but may cause harm if used inappropriately. We introduced an opioid stewardship program in three Melbourne hospitals to reduce the inappropriate use of opioids after patient discharge. The program had four pillars: prescriber education, patient education, a standardised quantity of discharge opioids, and general practitioner (GP) communication. Following introduction of the program, we undertook this prospective cohort study. The study aimed to describe post-program discharge opioid prescribing, patient opioid use and handling, and the impact of patient demographics, pain and surgical treatment factors on discharge prescribing. We also evaluated compliance with the program components. We recruited 884 surgical patients from the three hospitals during the ten-week study period. Discharge opioids were dispensed to 604 (74%) patients, with 20% receiving slow-release opioids. Junior medical staff undertook 95% of discharge opioid prescribing, which was guideline-compliant for 78% of patients. Of the patients discharged with opioids, a GP letter was sent for only 17%. Follow-up at two weeks was successful in 423 (70%) patients and in 404 (67%) at three months. At the three-month follow-up, 9.7% of patients reported ongoing opioid use; in preoperatively opioid naïve patients, the incidence was 5.5%. At the two-week follow-up, only 5% reported disposal of excess opioids, increasing to 26% at three months. Ongoing opioid therapy at three months in our study cohort (9.7%; 39/404) was associated with preoperative opioid consumption and higher pain scores at the three-month follow-up. The introduction of the opioid stewardship program resulted in highly guideline-compliant prescribing, but hospital-to-GP communication was uncommon and opioid disposal rates were low. Our findings suggest that opioid stewardship programs can improve postoperative opioid prescribing, use and handling, but the realisation of these gains will require effective program implementation.

Team Approach: Use of Opioids in Orthopaedic Practice.

The opioid epidemic represents a serious health burden on patients across the United States. This epidemic is particularly pertinent to the field of orthopaedics because it is one of the fields providing the highest volume of opioid prescriptions. The use of opioids before orthopaedic surgery has been associated with decreased patient-reported outcomes, increased surgery-related complications, and chronic opioid use. Several patient-level factors, such as preoperative opioid consumption and musculoskeletal and mental health conditions, contribute to the prolonged use of opioids after surgery, and various screening tools for identifying high-risk drug use patterns are available. The identification of these high-risk patients should be followed by strategies aimed at mitigating opioid misuse, including patient education, opioid use optimization, and a collaborative approach between health care providers.

Machine Learning Model Identifies Preoperative Opioid Use, Male Sex, and Elevated Body Mass Index as Predictive Factors for Prolonged Opioid Consumption Following Arthroscopic Meniscal Surgery

To develop a predictive machine learning model to identify prognostic factors for continued opioid prescriptions after arthroscopic meniscus surgery. Patients undergoing arthroscopic meniscal surgery, such as meniscus debridement, repair, or revision at a single institution from 2013 to 2017 were retrospectively followed up to 1 year postoperatively. Procedural details were recorded, including concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. The number of opioid prescriptions in each month was recorded. Primary analysis used was the multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that uses Bayes' theorem with an assumption of independence between variables. A total of 581 patients were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Multivariate logistic modeling was used; independent risk factors for opioid refills included male sex, larger body mass index, and chronic preoperative opioid use, while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revision procedures, and presence of arthritis graded by the Outerbridge classification were not significant predictors of postoperative opioid refills. The naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, positive predictive value (PPV) of 83%, and a detection rate of 78.2%. The two most important features in the model were preoperative opioid use and male sex. After arthroscopic meniscus surgery, preoperative opioid consumption and male sex were the most significant predictors for sustained opioid use beyond 1 month postoperatively. Intraoperative arthritis was not an independent risk factor for continued refills. A machine learning algorithm performed with high accuracy, although with a high false positive rate, to function as a screening tool to identify patients filling additional narcotic prescriptions after surgery. III, retrospective comparative study.

Does Preoperative Opioid Consumption Influence Patient Satisfaction following Total Knee Arthroplasty?

Chronic opioid use prior to total knee arthroplasty (TKA) has been implicated in adverse outcomes. The purpose of this study was to evaluate clinical outcome measures and patient satisfaction in patients with a history of preoperative chronic opioid use undergoing primary TKA. A retrospective cohort study was performed on 296 consecutive patients undergoing primary TKA. Seventy-four (25%) patients were identified with chronic preoperative opioid use (study group; 22 males, 52 females). A 3:1 matched cohort ratio of control versus study group was utilized resulting in a control group consisting of 222 patients (97 males, 125 females) without chronic opioid use prior to surgery. There was no statistically significant difference in age, BMI, or follow-up. Average follow-up was 23.4 months in the control group and 23.6 months in the study group (p = 0.87). Clinical data including patient satisfaction (Likert score), Knee Society (KS) Knee scores, KS Function scores, Forgotten Joint Score (FJS), length of stay (LOS), and complications were evaluated. Patient satisfaction at the most recent visit was 92.8% in the control group versus 83.8% in the chronic opioid group (p = 0.0016). Differences in patient-reported outcomes measures comparing the control and study cohorts included KS Function Score of 83.23 versus 75.31 (p = 0.0034). The FJS of 63.7 versus 58 (p = 0.1883) and the KS Knee Score of 89.5 versus 88.1 (p = 0.4075) were not significant. Postoperative opioid usage for the control versus the study group was 62/222 (27.9%) versus 56/74 (75.7%) at 4 to 8 weeks (p <0.0001), and 4/222 (1.80%) versus 27/74 (36.5%) at 12 months (p <0.0001). Overall complication occurrence was 18.9% in the study group versus 11.3% in the control group (p = 0.11). Patients with history of chronic preoperative opioid use had significantly lower patient satisfaction and KS Function scores and increased postoperative opioid usage at 12 months compared with patients without a history of opioid use prior to TKA.

Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty

BACKGROUNDPatients who undergo orthopedic procedures are often given excess opioid medication. Understanding the relationship between pain and opioid consumption following total hip arthroplasty (THA) is key to creating safe and effective opioid prescribing guidelines. AIMTo evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.METHODSWe retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale (VAS) pain and opioid medication questionnaires pre-and postoperatively. Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days. Survey results were divided into preoperative, postoperative days 1-7, postoperative days 8-14, and postoperative days 15-30 for analysis. Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’ preoperative status using hierarchical Poisson and linear regressions, respectively.RESULTSThere were 105 patients included. Mean VAS pain scores were the highest preoperatively 7.41 ± 1.72. However, VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores: postoperative day 1-7 (5.07 ± 1.79; P < 0.001), postoperative day 8-14 (3.60 ± 1.64; P < 0.001), and postoperative day 15-30 (3.15 ± 1.63; P < 0.001). Mean opioid pill consumption preoperatively was 0.68 ± 1.29 pills. Compared to preoperative opioid consumption, opioid use was significantly greater between postoperative days 1-7 (1.51 ± 1.58; P = 0.001) and postoperative days 8-14 (1.00 ± 1.27; P = 0.043). Opioid consumption declined below preoperative levels between postoperative days 15-30 (0.35 ± 0.72; P = 0.160) which correlates with a VAS pain score of 3.15. CONCLUSIONAll patients experienced significant benefit and pain relief from having undergone THA. Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30, which was associated with a VAS pain score of 3.15. These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.

Patients with preoperative opioid use and lower resilience scores are more likely to report inadequate pain control after total shoulder arthroplasty

BackgroundThe United States is in a prescriptive opioid crisis, and physicians have a responsibility to their patients and the healthcare system to mitigate irresponsible prescriptive practices. A patient’s preoperative opioid status and brief resilience score (BRS) may be used to individualize analgesic protocols and reduce opioid overprescription. The purpose of this study is to evaluate the relationship between preoperative resilience scores and patient-reported pain control after total shoulder arthroplasty (TSA). This study also examines reported pain control in patients with or without preoperative narcotic use 30 days before their procedure. MethodsPatients undergoing elective primary anatomic total shoulder arthroplasty (aTSA) or primary reverse total shoulder arthroplasty (rTSA) were asked to complete the BRS survey before their procedure and postoperative narcotic pain medication surveys at 1, 4, and 12 weeks after their operation. The patients were then stratified into 2 cohorts based on preoperative opioid usage status. Two-sample equal-variance t-tests were used to test for differences between resilience score group means and adequate pain control after TSA. The differences between preoperative opioid and no preoperative opioid usage cohorts, and perceived pain control and the number of oxycodone pills taken were analyzed for direction and statistical significance using t-tests for continuous variables and chi-squared tests for categorical variables. ResultsThe study cohort consisted of 218 patients, of whom 74 had preoperative opioid use (group O). Patients who reported inadequate pain control after TSA had consistently lower resilience scores at baseline. The BRS group means ± standard deviations after TSA for the adequate vs. inadequate pain control groups respectively were 3.84 vs. 3.48 (P = .010) at week 1, 3.83 vs. 3.53 (P = .055) at week 4, and 3.84 vs. 3.36 (P = .002) at week 12. Of the patients in group O (n = 74), a consistently smaller proportion of patients reported adequate pain control after TSA. Pain control rates among group O vs. nonusers/opioid-naïve patients (group N) respectively were 81.1% vs. 89.6% (P = .080) at week 1, 83.8% vs. 92.4% (P = .055) at week 4, and 82.4% vs. 93.0% (P = .016) at week 12. ConclusionA patient’s resilience score and preoperative opioid consumption are associated with postoperative pain control. Physicians may be able to use these 2 preoperative measures to better individualize postoperative narcotic prescriptive practices and reduce the number of unused opioids.

Poster 215: Application of Machine Learning for Predicting Opioid Use After Arthroscopic Meniscal Surgery

Objectives:To identify predictive factors for continued opioid prescriptions after arthroscopic meniscal resection or repair and develop a predictive machine learning model.Methods:Patients undergoing arthroscopic meniscal surgery between August 2013 and February 2017 at a single institution were retrospectively identified. Patient demographic variables were recorded including age, sex, body mass index, and history of chronic opioid usage (> 1 month). Procedural details were recorded such as concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. Types of opioid medications prescribed and in which months were documented. For primary analysis, we used a multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that utilizes Bayes’ theorem with an assumption of independence between the variables collected. The model randomly selected 70% of the sample to be trained on while 30% were tested.Results:A total of 735 patient were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Using multivariate logistic modeling, independent risk factors for opioid refills included Male sex, larger BMI, chronic preoperative opioid use while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revisions, and presence of arthritis graded by the Outerbridge classification were not significant predictors of opioid refills. The Naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, PPV of 83%, and a detection rate of 78.2%.Conclusions:After arthroscopic meniscus surgery, preoperative opioid consumption had the strongest association with sustained opioid use >1 month. Intraoperative arthritis was not an independent risk factor for continued refills. A novel machine learning algorithm performed with high accuracy and predictive ability to identify patients filling additional narcotic prescriptions after surgery.Figure 1.Cumulative hazard curve for the risk of using opioids up until 1 year postoperatively.Table 1.Multivariate logistic regression model for postoperative opioid refills.

Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies.

Objective In 2017, the United States officially declared opioid overuse a public health emergency. Due to a paucity of published benchmark data in skull base neurosurgery, we quantified postoperative opioid use in patients undergoing skull base craniotomies and identified factors that influence postoperative opioid use. Setting Tertiary academic medical center. Participants Patients who underwent elective craniotomies by two skull base neurosurgeons between January 2015 and May 2020. Main Outcome Measures Demographic and perioperative data were retrospectively extracted from the electronic medical record. Surgical approaches were categorized as having either "significant" or "minimal" muscle dissection. Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative opioid use at 24, 48, and 72 hours. Results We included 300 craniotomies, 206 were supratentorial and 94 were infratentorial. This included 195 women and 105 men, with a mean age of 54.9 years. In multivariable analysis, a history of anxiety or depression, preoperative opioid use, and a history of migraines independently predicted a significantly greater opioid use at 24, 48, and 72 hours. Increased age and minimal muscle dissection independently predicted lower opioid consumption. Sex, infratentorial versus supratentorial approach, length of surgery, and postoperative steroid use did not impact total opioid use. Conclusion Younger age, history of anxiety or depression, preoperative opioid consumption, preexisting history of migraines, and significant intraoperative muscle dissection were associated with higher postoperative opioid consumption. These risk factors provide insight on potential targets for minimizing postoperative opioids in craniotomies.

Associations of Smoking With Delirium and Opioid Use in Older Adults With Traumatic Hip Fracture.

Cigarette smoking is a risk factor for hip fractures, while risk factors for developing delirium include older age and preexisting cognitive impairment. We sought to determine whether smoking status is independently associated with delirium and pain outcomes. This was a prospective, observational cohort study of 442 older adults (65 to 90 years) admitted for traumatic hip fracture at five trauma centers. The primary exposure was smoking status (n = 43, 10%). Additional risk factors included demographics, injury characteristics, and medical interventions. Delirium (primary) and analgesia-related complications were examined with multivariable logistic regression, while analysis of covariance models were used to examine preoperative and postoperative pain scores and opioid consumption (oral morphine equivalents). Smokers had significantly worse outcomes compared with nonsmokers: delirium incidence was 16.3% versus 5.0% (adjusted odds ratio, 4.23; P = 0.005), analgesia complications developed in 30.2% versus 14.8% (adjusted odds ratio, 2.63; P = 0.01), and postoperative opioid consumption was greater (53 mg versus 33 mg, adjusted P = 0.04). Adjusted pain scores were not different between groups. Smoking status is associated with markedly worse outcomes in older adults with traumatic hip fracture. Smoking status should be considered in pain management protocols and for early screening and delirium prevention methods. On reasonable request.

Does In-Hospital Opioid Use Affect Opioid Consumption After Total Joint Arthroplasty?

Preoperative opioid use strongly correlates with greater postoperative opioid use and complications following total joint arthroplasty (TJA). However, there is a lack of information regarding the effect of opioid consumption during the hospital stay and within the operating room on postoperative opioid use. We retrospectively reviewed 369 consecutive patients undergoing primary TJA at an academic center over a 9-month period. Ninety-day preoperative and postoperative opioid prescriptions were obtained from the state's drug monitoring database. In-hospital opioid consumption data was obtained from the preoperative unit, operating room, postanesthesia care unit (PACU), and hospital floor. Multivariate analysis was utilized to compare patients' total in-hospital opioid consumption with their preoperative and postoperative use, along with opioid use throughout the hospitalization. Total in-hospital opioid consumption was independently associated with postoperative opioid use (rs= 0.17, P= .0010). Opioids consumed on the hospital floor correlated with opioid use in the preoperative unit (rs= 0.11, P= .0338) and PACU (rs= 0.15, P= .0032). Increased preoperative opioid consumption was the greatest risk factor for excessive postoperative use (rs= 0.44, P < .0001). A greater proportion of patients <65 years of age were high posthospital opioid consumers (P= .0146) and significantly more TKA patients were in the higher use groups (P= .0006). In-hospital opioid use is independently associated with preoperative and postoperative consumption. Preoperative opioid use remains the greatest risk factor for increased opioid consumption after TJA. Multimodal approaches to decrease reliance on opioids for pain control during hospitalization may offer hope to further decrease postoperative usage. III.

Effect of Preoperative Opiate Use on Outcomes After Posterior Lumbar Surgery

IntroductionThe prescription opioid epidemic and widespread use of narcotic medications have introduced new challenges when treating patients undergoing spine surgery. Given the ubiquity of preoperative opioid consumption amongst patients undergoing spine surgery, further research is needed to characterize perioperative risks. Our goal is to compare outcomes following primary lumbar decompression, instrumentation, and fusion based on preoperative opioid prescriptions.MethodsPatients older than 18 years of age who underwent a primary one- to two-level lumbar decompression, instrumentation, and fusion were included in the study. Patients with known malignancy, surgery involving three or more lumbar levels, current or previous use of neuromodulation, revision surgery, anterior or far lateral interbody fusions, acute fractures, or other concurrent procedures were excluded. Patients were divided into chronic opioid therapy (COT; over six months), acute opioid therapy (AOT; up to six months), and opiate-naïve groups. Opioid prescriptions, demographics, smoking status, readmission rates within one year, and reoperation rates within two years were recorded based on electronic medical record documentation.ResultsOut of 416 patients identified, 114 patients met the inclusion criteria. Thirty-eight patients (33.3%) were on COT, 38 patients (33.3%) were on AOT, and 38 patients (33.3%) were opioid naïve preoperatively. Readmission rates within one year for COT, AOT, and opioid naïve patients were 34.2%, 26.3%, and 10.5%, respectively (p=0.047). Reoperation rates within two years for COT, AOT, and opioid naïve patients were 34.2%, 15.8%, and 13.2%, respectively (p=0.049). We also found current or former smokers were more likely to be on AOT or COT than never smokers (78.4% vs. 57.1%; p=0.017). ConclusionLong-term opiate use is associated with an increased risk for readmission within one year and revision within two years. Physicians should discuss the increased risks of readmission and revision surgery associated with lumbar decompression and fusion seen in patients on preoperative opioid therapy.

Comparison of Opioid Consumption Patterns of Three Interbody Fusion Surgical Techniques.

Retrospective review. With increased awareness of the opioid crisis in spine surgery, the focus postoperatively has shifted to managing surgical site pain while minimizing opioid use. Numerous studies have compared outcomes and fusion status of different interbody fusion techniques; however, there is limited literature evaluating opioid consumption postoperatively between techniques. The aim of this study was to assess in-house and postoperative opioid consumption across 3 surgical techniques. Patients were stratified by technique: posterior lumbar interbody fusion (PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and cortical screw (CS) instrumentation with interbody fusion. Age, ASA, BMI, depression, preoperative opioid use, EBL, and OR time were recorded and compared across surgical groups using Welch's ANOVA and chi-square analysis. Total morphine equivalent dose (MED) was tabulated for both in-house consumption and postoperative prescriptions and was compared across surgical techniques using Welch's ANOVA analysis, Mann Whitney U tests, and linear regression. Two hundred and thirty nine patients underwent one- or two-level posterior lumbar interbody fusion between 2016 and 2020. One hundred and twenty one patients underwent CS instrumentation, 95 underwent PLIF, and 83 underwent MIS-TLIF. There was a significantly higher percentage of patients who had a history of depression and preoperative opioid consumption in the CS group (P = .001, P = .009). CS instrumentation required significantly less total post-op opioids per kilogram bodyweight compared to MIS-TLIF and PLIF surgeries (P = .029). Patients who underwent CS instrumentation required less opioids postoperatively. CS instrumentation may be associated with less postoperative pain due to the less invasive approach, however, patient education and prescriber practice also play a role in postoperative opioid consumption.

Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair

PurposeTo evaluate patient use of opioids following arthroscopic rotator cuff repair, including the number of days and number of pills when used in combination with non-opioid medications and to determine whether patients were satisfied with their pain management and if variables such as age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative opioid consumption, size of the rotator cuff tear, or anxiety/depression affected pain management.MethodsThis was a prospective cohort study of 117 prospectively enrolled patients older than the age of 18 years undergoing primary arthroscopic rotator cuff repair. All patients completed preoperative and 2-week postoperative questionnaires to assess their pain and satisfaction with pain management. Univariate and multivariate analyses were performed to evaluate the association of patient characteristics with satisfaction of pain control and amount/duration of opioids postoperatively.ResultsPatients required a median of 18 opioid pain pills or 135 morphine milligram equivalents (interquartiles, 6-35 pills) postoperatively over 6.9 ± 5.1 days. In total, 65% of patients took opioid pain medications for 7 days or fewer. On postoperative day 2, patients reported a VAS pain score of 6.6 ± 2.8 and at the 2-week postoperative visit, mean visual analog scale pain score was 3.5 ± 2.5. Differences in age, sex, body mass index, duration of symptoms, anticipation of postoperative pain, preoperative 2-item Patient Health Questionnaire, 2-item Pain Self-Efficacy Questionnaire, current opioid use, and surgical characteristics had no effect on, or association with, satisfaction with pain management postoperatively.ConclusionsFollowing arthroscopic rotator cuff repair, patients can achieve satisfactory pain control using a multimodal approach with a median of 18 opioid pills (range 6-35 pills) over 6.9 ± 5.1 days when used in combination with non-opioid pain medications. Overall, 74.4% of patients were satisfied with their postoperative pain management.Level of EvidenceLevel II; Prospective cohort study.

P94. Preoperative opioid use poorly correlates with mental health in adult spinal deformity: Time to rethink foregone conclusions

<h3>BACKGROUND CONTEXT</h3> Preoperative opioid consumption, poor mental health, and lower socioeconomic status are each associated with worse surgical outcomes for adult spinal deformity (ASD). Little data exits evaluating preoperative morphine milligram equivalent (MME) consumption and preoperative mental health, social function, and socioeconomic status in ASD. <h3>PURPOSE</h3> Evaluate the correlations between preoperative daily MME consumption and preoperative depression, anxiety, mental health scores, and socioeconomic status for ASD patients prior to receiving reconstructive ASD surgery. We hypothesized that preoperative MME consumption correlates with preoperative depression, anxiety, poor mental health, poor social function, and poor socioeconomic status in ASD. <h3>STUDY DESIGN/SETTING</h3> Preoperative analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Edmonton Frailty Index (EFI score), grip strength, Veterans Rand Health Questionnaire (VR-12), Oswestry Disability Index (ODI), daily morphine milligram equivalent consumption (MME), PROMIS-Pain Interference (PROMIS-PI), PROMIS-Physical Function (PROMIS-PF), PROMIS-Depression (DEP), PROMIS-Anxiety (ANX), PROMIS-Satisfaction with Social Roles (SR) and PROMIS-Satisfaction with Discretionary Social Activities (SDA) computer adaptive tests (CATs), Area Deprivation Index (ADI) scores. <h3>METHODS</h3> From 2018-2020, ASD patients were prospectively enrolled into a multicenter study. Preoperative MME was calculated. Preoperative PROMIS-DEP, PROMIS-ANX, PROMIS=SR, PROMIS-SDA, PROMIS-PI and PF, SRS-22r total and domain scores, and VR-12 mental component summary (MCS) were calculated. ADI scores were collected to assess socioeconomic status, as previously described. MME data were log transformed and two-tailed Pearson correlation coefficients calculated. Correlation strengths were interpreted according to Cohen. Confidence intervals were created with 1,000 sample bootstrapping. <h3>RESULTS</h3> A total of 207/207 patients enrolled were evaluated; mean age 61 years (18-81). Preoperative opioid consumption was reported in 38% patients (n=78; mean preoperative MME 22.5 mg, range 1-420 mg). Preoperative MME did not correlate with PROMIS-ANX (p=0.07) and did not correlate with socioeconomic status (ADI; p=0.37). Preoperative MME showed small correlations with PROMIS-DEP (r=0.2, p=0.01), VR-12 MCS (r=-.2, p=0.002), and SRS-Mental Health (r=-0.2, p=0.005). Preoperative MME showed moderate correlations with PROMIS-PI (r=0.4, p<0.0001), PROMIS-PF (r=-0.4, p<0.0001), SRS-Pain (r=-0.5, p<0.0001), SRS-Function (r=-0.4, p<0.0001), PROMIS-SR (r=-0.3, p<0.0001) and PROMIS-SSA (r=-0.4, p<0.0001). <h3>CONCLUSIONS</h3> Prospective evaluation of 207 ASD patients demonstrated minimal to no correlations between preoperative MME consumption and preoperative anxiety, depression or low socioeconomic status. Preoperative MME consumption demonstrated moderate correlations with preoperative pain, physical function, and social function scores. The negative impacts of opioid consumption on physical measures are likely independent of psychosocial variables in ASD. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.