PMID- 38365008
OWN - NLM
STAT- Publisher
LR  - 20240222
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
DP  - 2024 Feb 14
TI  - Association between opioid utilization and patient reported outcome measures 
      following lumbar spine surgery.
LID - S1529-9430(24)00075-5 [pii]
LID - 10.1016/j.spinee.2024.02.004 [doi]
AB  - BACKGROUND CONTEXT: The patient-reported outcomes measurement information system 
      (PROMIS), created by the National institute of Health, is a reliable and valid 
      survey for patients with lumbar spine pathology. Preoperative opioid use has been 
      shown to be an important predictor variable of self-reported health status in 
      legacy patient reported outcome measures. PURPOSE: To investigate the impact of 
      chronic preoperative opiate use on PROMIS survey scores. STUDY DESIGN: 
      Retrospective database analysis. PATIENT SAMPLE: Between March 2019 and November 
      2021, 227 patients underwent lumbar decompression +/- </= 2 level fusion. Fifty-seven 
      patients (25.11%) had chronic preoperative opioid use. OUTCOME MEASURES: Oswestry 
      disability index (ODI) and PROMIS survey scores. METHODS: A retrospective 
      analysis of a prospectively maintained single center patient-reported outcome 
      database was performed with a minimum of 2 year follow-up. PROMIS Anxiety, 
      Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep 
      disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative 
      intake with subsequent follow-up at 6, 12, and 24 months postoperatively. 
      Patients were grouped into chronic opioid users as defined by >6-month duration 
      of use. Differences in mean survey scores were evaluated using Welch t-tests. 
      RESULTS: Two hundred and twenty-seven patients met our inclusion criteria of 
      completed PROMIS surveys at the designated timepoints. A total of 57 (25.11%) 
      were chronic opioid users (COU) prior to surgery. Analysis of patient-reported 
      health outcomes shows that long term opioid use correlated with worse ODI and 
      PROMIS scores at baseline compared to nonchronic users (NOU). At 1 and 2 year 
      follow-up, the COU cohort continued to have significantly worse ODI, PROMIS 
      Fatigue, PF, PI, SD, and SR scores. There is a statistical difference in the 
      magnitude of change in health status between the 2 cohorts at 1 year follow-up in 
      PROMIS Depression (-5.04+/-7.88 vs. -2.49+/-8.73, p=.042), PF (6.25+/-7.11 vs. 
      9.03+/-9.04, p=.019), and PI (-7.40+/-7.37 vs. -10.58+/-9.87, p=.011) and 2 year 
      follow-up in PROMIS PF (5.58+/-6.84 vs. 7.99+/-9.64, p=.041) and PI (-6.71+/-8.32 vs. 
      -9.62+/-10.06, p=.032). Mean improvement in PROMIS scores for the COU cohort at 2 
      year follow-up exceeded minimal clinically important difference (MCID) in all 
      domains except PROMIS Depression, SR and SD. CONCLUSION: Patients with chronic 
      opioid use status have worse baseline PROMIS scores compared with patients who 
      had nonchronic use. However, patients in the COU cohort displayed clinically 
      significant postoperative improvement in multiple PROMIS domains. These results 
      show that patients with chronic opioid use can benefit greatly from surgical 
      intervention and will allow physicians to better set expectations with their 
      patients.
CI  - Copyright (c) 2024 The Author(s). Published by Elsevier Inc. All rights reserved.
FAU - Wague, Aboubacar
AU  - Wague A
AD  - University of California San Francisco School of Medicine, San Francisco, CA 
      94143, USA. Electronic address: aboubacar.wague@ucsf.edu.
FAU - O'Donnell, Jennifer M
AU  - O'Donnell JM
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA.
FAU - Stroud, Sarah
AU  - Stroud S
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA.
FAU - Filley, Anna
AU  - Filley A
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA.
FAU - Rangwalla, Khuzaima
AU  - Rangwalla K
AD  - University of California San Francisco School of Medicine, San Francisco, CA 
      94143, USA.
FAU - Baldwin, Avionna
AU  - Baldwin A
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA.
FAU - El Naga, Ashraf N
AU  - El Naga AN
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA; Zuckerberg San Francisco General Hospital, San 
      Francisco, CA 94110, USA.
FAU - Gendelberg, David
AU  - Gendelberg D
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA; Zuckerberg San Francisco General Hospital, San 
      Francisco, CA 94110, USA.
FAU - Berven, Sigurd
AU  - Berven S
AD  - University of California San Francisco, Department of Orthopaedic Surgery, San 
      Francisco, CA 94143, USA.
LA  - eng
PT  - Journal Article
DEP - 20240214
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
OTO - NOTNLM
OT  - Depression
OT  - Fatigue
OT  - Lumbar degenerative
OT  - Opiates
OT  - Opioids
OT  - Oswestry disability index
OT  - Patient-reported outcome measurement information system
OT  - Physical function
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/02/17 10:43
MHDA- 2024/02/17 10:43
CRDT- 2024/02/16 19:16
PHST- 2023/06/18 00:00 [received]
PHST- 2024/01/10 00:00 [revised]
PHST- 2024/02/06 00:00 [accepted]
PHST- 2024/02/17 10:43 [pubmed]
PHST- 2024/02/17 10:43 [medline]
PHST- 2024/02/16 19:16 [entrez]
AID - S1529-9430(24)00075-5 [pii]
AID - 10.1016/j.spinee.2024.02.004 [doi]
PST - aheadofprint
SO  - Spine J. 2024 Feb 14:S1529-9430(24)00075-5. doi: 10.1016/j.spinee.2024.02.004.