Perioperative Opioid Consumption in Patients Who Undergo Surgery Due to Spine-related Pain: A Danish Nationwide Cohort Study.

Abstract

Retrospective cohort study. The purpose of the current study is to describe long-term opioid use following lumbar spine surgery and, to investigate risk factors associated with prolonged use of opioids in patients undergoing spine surgery to treat chronic pain. During the last decade, the use of opioids in management of nonmalignant pain has been a topic of interest to surgeons and politicians worldwide with reference to the "opioid epidemic" in the United States. Although WHO guidelines advice against use of opioids to treat chronic low back pain in patients with degenerative spine orders, such therapy is still administered to vast numbers of patients all over the world. This is an observational study of 14,082 patients based on a nationwide database of spine surgeries (DaneSpine) during the period 2016-2022. We included patients who underwent lumbar spine surgery to treat spinal stenosis, spondylolisthesis, and disc herniation. Statistical analysis included descriptive statistics and relative risk analysis for factors associated with one-year postoperative opioid use. We had available data on preoperative and postoperative use of pain medicine and opioids on 14,082 patients who underwent spine surgery due to spinal stenosis (n=7932), disc herniation (n=4573), and spondylolisthesis (n=1577). Thirty-six percent of patients were on prescription opioids before surgery, as compared with 17% of patients at 1-year follow-up after surgery ( P <0.001).Overall, patients with preoperative opioid use had an increased relative risk (RR) of 4.70 ( P =0.002) of being prolonged opioid users in all patient groups combined. Modifiable risk factors for prolonged postoperative opioid use included pain duration, body mass index, and smoking. While opioid use is diminished overall during the seven-year study period, and most patients came of opioids after surgery, we found that preoperative opioid use was the strongest predictor for prolonged postoperative use.