Review Question - QID 214162

Chronic preoperative opioid use has been associated with prolonged hospital stays following lumbar spine surgery.

Lumbar spinal stenosis most commonly occurs from acquired degenerative changes to the intervertebral discs and facet joint leading to bulging discs, osteophytes, and buckled ligamentum flavum. Radiculopathy and neurogenic claudication develop from compression of the thecal sac in the central canal and neuroforaminal stenosis. Nonoperative management includes physical therapy, epidural steroid injections, NSAIDs, and activity modifications. In some cases, patients may be prescribed opioid medications, which is not formally endorsed by national guidelines. Patients on preoperative chronic opioids that require surgical intervention typically have increased hospital stays, reduced improvement in patient-reported outcomes, increased treatment costs, and difficulty with postoperative analgesia.

Vogt et al. performed a cross-sectional study of patients treated for lower back pain at the University of Pittsburgh Health System in 2001. They reported a $1.4 million plan cost for analgesic medication prescriptions, with opioid prescriptions being associated with higher imaging and physical therapy service claims. The authors concluded that the use of opioids is a major cost for the health system and should be prescribed based on the national guidelines for the treatment of lower back pain.

Martell et al. performed a systematic review of the literature regarding the prevalence and effectiveness of opioids for the treatment of lower back pain. The authors reported that opioids did not result in a significant reduction in pain from baseline measures and there was an associated lifetime substance abuse prevalence of 36% to 56%. They concluded that long-term pain relief with narcotics is unclear and associated with a high prevalence of substance abuse and aberrant medication-taking behaviors.

Armaghani et al. performed a prospective cohort study of 583 patients examining the effects of preoperative narcotic use on postoperative complications and length of hospital stay following spine surgery. The authors reported a significant association with postoperative complications in current smokers and prolonged hospital stays in patients with depression and preoperative narcotic usage. The authors concluded that preoperative opioid use is a risk factor for prolonged hospital stays with every 100 mg of daily morphine equivalents extending postoperative stay by 1.1 days.

Incorrect Answers:
Answer 1: Preoperative opioid use has not been found to affect surgical site infection rates.
Answer 3: Preoperative opioid use has been associated with increased treatment costs, both preoperatively and postoperatively.
Answer 4: Postoperative pain control is typically more challenging in patients with chronic preoperative opioid use.
Answer 5: Preoperative opioid use is associated with decreased improvement in patient-reported outcomes following spine surgery.