Chronic Preop Opioid Use = Poor Postop in 2,128 Patient Study

To assess the relationship between preoperative chronic opioids and opioid dosage with patient-reported outcomes, a multicenter team examined the records of patients who underwent elective spine surgery from 2010 and 2017.

Their work, “Preoperative Opioids and 1-year Patient-reported Outcomes After Spine Surgery,” was published in the June 15, 2019 edition of Spine.

Jeffrey Hills, M.D., is with the Department of Orthopaedics and Rehabilitation at Vanderbilt University Medical Center in Nashville. A co-author on this work, Dr. Hills commented to OTW, “It has been common knowledge for several years now that patients on long-term opioids suffer pain that is incredibly difficult to control after surgery that persists in the postoperative period.”

“In general, patients on long-term opioids appeared to not do as well and be less satisfied with their outcomes. There have been multiple studies evaluating the impact of preoperative opioid dosage, but we were interested in determining how dosage and duration of opioids prior to surgery played a role in long-term, patient reported outcomes.”

For their study, the investigators examined records for 2,128 patients and identified preoperative chronic opioid therapy in 21% of the patients. They also documented that preoperative chronic opioid use was significantly correlated with sub-optimal improvements at the 1-year mark for extremity pain, axial pain, function, quality of life, general dissatisfaction, 90-day complication rates and postoperative chronic opioid use.

According to the study authors, “Our general conclusions from this study, were that patients on long-term opioids prior to surgery were at significantly lower odds of achieving improvement or being satisfied at 1 year after surgery, regardless of the dosage they take.”

“It is important that patients be made aware of our study and other similar studies. Patients taking opioids are taking them because these medications are supposed to be helping with their pain, when in fact our study indicates that these patients actually have worse pain. This is likely the result of opioid-induced hyperalgesia, in which patients on long-term opioids actually are having worse pain than those not on opioids.”

“Prior to proceeding with any elective surgery, patients should be carefully counseled and presented with these studies to show that improvement after surgery is significantly less likely if taking opioids prior to surgery. Whenever possible, all attempts should be made to wean patients completely off opioids prior to an elective spine surgery.”

“If patients have only been on opioids for a brief period of time prior to surgery, this likely will not have a substantial impact on their outcome, regardless of the dosages. The patients to be concerned about are the ones that have been on opioids for a longer period of time, regardless of their dosage. Thus, it is unclear if simply weaning patients to below a certain threshold prior to surgery would offer any benefit. Opioid cessation will likely offer the best odds of improvement following an elective surgery.”