PMID- 28973646
OWN - NLM
STAT- MEDLINE
DCOM- 20190916
LR  - 20190916
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 83
IP  - 2
DP  - 2018 Aug 1
TI  - Is There a Preoperative Morphine Equianalgesic Dose that Predicts Ability to 
      Achieve a Clinically Meaningful Improvement Following Spine Surgery?
PG  - 245-251
LID - 10.1093/neuros/nyx382 [doi]
AB  - BACKGROUND: Preoperative opioid use is widespread and associated with worse 
      patient-reported outcomes following spine surgery. OBJECTIVE: To calculate a 
      threshold preoperative morphine equianalgesic (MEA) dose beyond which patients 
      are less likely to achieve the minimum clinically important difference (MCID) 
      following elective surgery for degenerative spine disease. METHODS: The study 
      included 543 cervical and 1293 lumbar patients. Neck Disability Index and 
      Oswestry Disability Index scores were collected at baseline and 12 mo 
      postoperatively. Preoperative MEA doses were calculated retrospectively. 
      Multivariate logistic regression was then performed to determine the relationship 
      between MEA dose and the odds of achieving MCID. As a part of this regression, 
      Bayesian inference and Markov Chain Monte Carlo methods were used to estimate the 
      values of inflection points (or "thresholds") in MEA. RESULTS: Overall, 1020 
      (55.5%) patients used preoperative opioids. A total of 50.3% of cervical and 
      61.9% of lumbar patients achieved MCID. The final logistic regression model 
      demonstrated that MCID achievement decreased significantly when mean preoperative 
      MEA dose exceeded 47.8 mg/d, with a 95% credible interval of 29.0 to 60.0 mg/d. 
      CONCLUSION: Minimum and maximum MEA doses exist, between which increasing opioid 
      dose is associated with decreased ability to achieve clinically meaningful 
      improvement following spine surgery. Patients with preoperative MEA dose 
      exceeding 29 mg/d, the lower limit of the 95% credible interval for the mean MEA 
      dose above which patients exhibit significantly decreased achievement of MCID, 
      may be considered for preoperative opioid weaning.
FAU - Wick, Joseph B
AU  - Wick JB
AD  - Vanderbilt University School of Medi-cine, Nashville, Tennessee.
FAU - Sivaganesan, Ahilan
AU  - Sivaganesan A
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
FAU - Chotai, Silky
AU  - Chotai S
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
AD  - Department of Orthopedic Surgery, Vanderbilt University Medi-cal Center, 
      Nashville, Tennessee.
FAU - Archer, Kristin R
AU  - Archer KR
AD  - Department of Orthopedic Surgery, Vanderbilt University Medi-cal Center, 
      Nashville, Tennessee.
AD  - De-partment of Physical Medicine and Rehabilitation, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
FAU - Posey, Samuel L
AU  - Posey SL
AD  - Vanderbilt University School of Medi-cine, Nashville, Tennessee.
FAU - Evans, Parker T
AU  - Evans PT
AD  - Vanderbilt University School of Medi-cine, Nashville, Tennessee.
FAU - Campbell, Joel R
AU  - Campbell JR
AD  - Department of Orthopedic Surgery, Vanderbilt University Medi-cal Center, 
      Nashville, Tennessee.
FAU - Devin, Clinton J
AU  - Devin CJ
AD  - Department of Neurological Surgery, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
AD  - Department of Orthopedic Surgery, Vanderbilt University Medi-cal Center, 
      Nashville, Tennessee.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Adult
MH  - Analgesics, Opioid/*administration & dosage
MH  - Back Pain/*drug therapy/*surgery
MH  - Bayes Theorem
MH  - Disability Evaluation
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Minimal Clinically Important Difference
MH  - Patient Reported Outcome Measures
MH  - *Preoperative Period
MH  - Retrospective Studies
MH  - Spine/*surgery
MH  - Treatment Outcome
EDAT- 2017/10/04 06:00
MHDA- 2019/09/17 06:00
CRDT- 2017/10/04 06:00
PHST- 2017/02/15 00:00 [received]
PHST- 2017/06/24 00:00 [accepted]
PHST- 2017/10/04 06:00 [pubmed]
PHST- 2019/09/17 06:00 [medline]
PHST- 2017/10/04 06:00 [entrez]
AID - 4035747 [pii]
AID - 10.1093/neuros/nyx382 [doi]
PST - ppublish
SO  - Neurosurgery. 2018 Aug 1;83(2):245-251. doi: 10.1093/neuros/nyx382.