Comparing Postoperative Opioid Use in Primary and Revision Lumbar Fusion: A Propensity-Matched Analysis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-02-17 DOI:10.1016/j.wneu.2025.123800

Jonathan Dalton, Jarod Olson, Nicholas B Pohl, Rajkishen Narayanan, Omar H Tarawneh, Yunsoo Lee, Michael V Carter, Gokul Karthikeyan, Logan Witt, Aayush Mehta, John J Mangan, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler

{"title":"Comparing Postoperative Opioid Use in Primary and Revision Lumbar Fusion: A Propensity-Matched Analysis.","authors":"Jonathan Dalton, Jarod Olson, Nicholas B Pohl, Rajkishen Narayanan, Omar H Tarawneh, Yunsoo Lee, Michael V Carter, Gokul Karthikeyan, Logan Witt, Aayush Mehta, John J Mangan, Mark F Kurd, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.1016/j.wneu.2025.123800","DOIUrl":null,"url":null,"abstract":"Objective: This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.Methods: Patients who underwent primary or revision 1-2 level lumbar fusion (2017-2021) were included in this study. The state PDMP was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were sub-stratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.Results: The final cohort included 216 primary and 216 revision 1-2 level lumbar fusion patients. The average time between index procedure and revision was 7.54 ± 9.22 years. Opioid use was similar within one-year pre-operatively and at all postoperative time points (up to 1 year) between primary and revision fusion patients. Benzodiazepine, muscle relaxants, and gabapentinoid use was also similar at all pre-operative and post-operative time points. Further stratification of revision lumbar fusion patients found that persistent postoperative opioid use patients had a higher incidence of preoperative opioid use within the year prior to surgery with increased number of prescriptions (7.22 ± 7.62 vs. 1.38 ± 2.32; p<0.001) and MME totals (298 ± 565 vs. 45.6 ± 84.4; p<0.001).Conclusions: Postoperative opioid requirements were similar amongst patients undergoing primary versus revision lumbar fusion. In the revision cohort, persistent postoperative opioid users had higher preoperative opioid use, which is supported by prior literature. Although revision lumbar fusion has been reported to lead to less pain improvement, this study's findings suggest these procedures may not lead to higher rates of persistent opioid use postoperatively.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123800"},"PeriodicalIF":1.9000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2025.123800","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: This study compared postoperative opioid use for patients undergoing short segment primary versus revision lumbar fusion.

Methods: Patients who underwent primary or revision 1-2 level lumbar fusion (2017-2021) were included in this study. The state PDMP was reviewed for all patients to quantify preoperative and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use. A 1:1 propensity match was performed to match primary lumbar fusion patients with revision lumbar fusion patients. Revision lumbar fusion patients were sub-stratified into those with or without persistent postoperative opioid use to identify demographic differences between these patient cohorts.

Results: The final cohort included 216 primary and 216 revision 1-2 level lumbar fusion patients. The average time between index procedure and revision was 7.54 ± 9.22 years. Opioid use was similar within one-year pre-operatively and at all postoperative time points (up to 1 year) between primary and revision fusion patients. Benzodiazepine, muscle relaxants, and gabapentinoid use was also similar at all pre-operative and post-operative time points. Further stratification of revision lumbar fusion patients found that persistent postoperative opioid use patients had a higher incidence of preoperative opioid use within the year prior to surgery with increased number of prescriptions (7.22 ± 7.62 vs. 1.38 ± 2.32; p<0.001) and MME totals (298 ± 565 vs. 45.6 ± 84.4; p<0.001).

Conclusions: Postoperative opioid requirements were similar amongst patients undergoing primary versus revision lumbar fusion. In the revision cohort, persistent postoperative opioid users had higher preoperative opioid use, which is supported by prior literature. Although revision lumbar fusion has been reported to lead to less pain improvement, this study's findings suggest these procedures may not lead to higher rates of persistent opioid use postoperatively.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS