Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study

Peter Uhrbrand; Peter Helmig; Simon Haroutounian; Simon Tilma Vistisen; Lone Nikolajsen

doi:10.1097/BRS.0000000000004039

Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study

Peter Uhrbrand, Peter Helmig, Simon Haroutounian, Simon Tilma Vistisen, Lone Nikolajsen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Study Design.Single-center, investigator-initiated, prospective cohort study.Objective.This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge.Summary of Background Data.Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids.Methods.Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey.Results.Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months.Conclusion.Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.

Original language	English
Journal	Spine
Volume	46
Issue	20
Pages (from-to)	1428-1435
Number of pages	8
ISSN	0362-2436
DOIs	https://doi.org/10.1097/BRS.0000000000004039
Publication status	Published - Oct 2021

Keywords

Analgesics, Opioid/therapeutic use
Humans
Opioid-Related Disorders/epidemiology
Pain, Postoperative/diagnosis
Prospective Studies
Spine/surgery

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10.1097/BRS.0000000000004039

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@article{0e6b7f59c08c47deb4dd8b078379952a,

title = "Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study",

abstract = "Study Design.Single-center, investigator-initiated, prospective cohort study.Objective.This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge.Summary of Background Data.Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids.Methods.Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey.Results.Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months.Conclusion.Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.",

keywords = "Analgesics, Opioid/therapeutic use, Humans, Opioid-Related Disorders/epidemiology, Pain, Postoperative/diagnosis, Prospective Studies, Spine/surgery",

author = "Peter Uhrbrand and Peter Helmig and Simon Haroutounian and Vistisen, {Simon Tilma} and Lone Nikolajsen",

year = "2021",

month = oct,

doi = "10.1097/BRS.0000000000004039",

language = "English",

volume = "46",

pages = "1428--1435",

journal = "Spine",

issn = "0362-2436",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "20",

}

TY - JOUR

T1 - Persistent Opioid Use After Spine Surgery

T2 - A Prospective Cohort Study

AU - Uhrbrand, Peter

AU - Helmig, Peter

AU - Haroutounian, Simon

AU - Vistisen, Simon Tilma

AU - Nikolajsen, Lone

PY - 2021/10

Y1 - 2021/10

N2 - Study Design.Single-center, investigator-initiated, prospective cohort study.Objective.This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge.Summary of Background Data.Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids.Methods.Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey.Results.Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months.Conclusion.Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.

AB - Study Design.Single-center, investigator-initiated, prospective cohort study.Objective.This study aimed to determine patient-reported reasons for persistent opioid use following elective spine surgery, assess the frequency of withdrawal symptoms, and characterize pain-related care sought after discharge.Summary of Background Data.Patients are often prescribed opioids at discharge from hospital following surgery. Several studies have shown that a large number of patients fail to discontinue opioid treatment and use opioids even months to years after surgery. Spine surgery has proven to be a high-risk procedure in regard to persistent opioid use. There is, however, limited evidence on why patients continue to take opioids.Methods.Three hundred patients, scheduled to undergo spine surgery at Aarhus University Hospital, Denmark, were included. Baseline characteristics and discharge data on opioid consumption were collected. Data on opioid consumption, patient-reported reasons for opioid use, withdrawal symptoms, and pain-related care sought were collected at 3- and 6-month follow-up via a REDCap survey.Results.Before surgery, opioid use was reported in 53% of patients. Three months after surgery, opioid use was reported in 60% of preoperative opioid-users and in 9% of preoperative opioid non-users. Patients reported the following reasons for postoperative opioid use: treatment of surgery-related pain (53%), treatment of surgery-related pain combined with other reasons (37%), and reasons not related to spine surgery (10%). Withdrawal symptoms were experienced by 33% of patients during the first 3 months after surgery and were associated with failure to discontinue opioid treatment (P < 0.001). Half of patients (52%) contacted health care after discharge with pain-related topics the first 3 months.Conclusion.Patients use opioids after spine surgery for reasons other than surgery-related pain. Withdrawal symptoms are frequent even though patients are given tapering plans at discharge. Further studies should address how to facilitate successful and safe opioid tapering in patients undergoing spine surgery.Level of Evidence: 3.

KW - Analgesics, Opioid/therapeutic use

KW - Humans

KW - Opioid-Related Disorders/epidemiology

KW - Pain, Postoperative/diagnosis

KW - Prospective Studies

KW - Spine/surgery

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U2 - 10.1097/BRS.0000000000004039

DO - 10.1097/BRS.0000000000004039

M3 - Journal article

C2 - 34559754

SN - 0362-2436

VL - 46

SP - 1428

EP - 1435

JO - Spine

JF - Spine

IS - 20

ER -

Persistent Opioid Use After Spine Surgery: A Prospective Cohort Study

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