12-Month Patient-Reported Outcomes Among Urine Toxicology-Identified Substance Users After Elective Spine Surgery: A Prospective Longitudinal Cohort Study.

Abstract

While prior studies have examined the role of opioids, alcohol, and marijuana use on early postoperative outcomes after elective spine surgery, longitudinal studies evaluating the impact of objectively identified preoperative substance use on 12-month outcomes are lacking. This prospective cohort study included adults who underwent preoperative urine toxicology (UTox) screening followed by elective spine surgery between September 2020 and February 2024. Chart review and phone outreach were completed to collect demographic, UTox, surgical, and patient-reported outcomes measures (PROMs) data up to 1-year postoperatively. PROMs, overall and stratified by UTox-identified alcohol, marijuana, and opioid use, were evaluated using repeated-measures analysis of variance (ANOVA) and mixed-effects regression analyses, adjusting for age, sex, BMI, comorbidities, and neurosurgical history. Among 185 participants (mean age 59.5, 57% female), preoperative UTox revealed 16% alcohol use, 23% marijuana use, 21% opioid use, and 39% nonsubstance use. Higher UTox-identified alcohol (16% vs 46%, P < .001) and drug use (45% vs 15%, P < .001) was observed relative to patient reports. Postoperatively, Oswestry Disability Index (ODI) (Preop = 58.9, 3-month = 41.8, 12-month = 54.0, P < .001) and Visual Analog Scale (VAS) (Preop = 7.1, 3-month = 4.7, 12-month = 5.9, P < .001) showed improvements till 3 months and subsequent decline till 12 months. These trends were consistent across cohorts, except opioid users who showed no differences in ODI (P = .762) or VAS (P = .059) across time points. Within-subject mixed-effects regressions revealed that ODI and VAS decreased by 5.7 and 0.8 points per month till 3 months, and increased by 1.1 and 0.1 points per month till 12 months, respectively (P < .05). This was also consistent across cohorts except opioid users, who showed no significant postoperative changes in ODI (P = .451) or VAS (P = .096). Objectively measured preoperative alcohol and marijuana use were not associated with altered postoperative outcomes whereas opioid use contributed to lack of early postoperative improvement and worse PROMs at 12 months. UTox screening may aid perioperative decision making, optimize rehabilitation strategies, and improve postoperative recovery. Level II, Prognostic Study.