Abdullah Ghali, Jad Lawand, Aaron Singh, Alexander Mihas, Meghana Jami, Anthony Farhat, Lorenzo Deveza
{"title":"既往抗抑郁药物处方与颈椎手术中更多阿片类药物处方和并发症相关：一项倾向匹配队列研究","authors":"Abdullah Ghali, Jad Lawand, Aaron Singh, Alexander Mihas, Meghana Jami, Anthony Farhat, Lorenzo Deveza","doi":"10.1097/BSD.0000000000001730","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study of national database.</p><p><strong>Objective: </strong>This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.</p><p><strong>Summary of background data: </strong>Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.</p><p><strong>Methods: </strong>Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.</p><p><strong>Results: </strong>In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group.</p><p><strong>Conclusions: </strong>Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery: A Propensity Matched Cohort Study.\",\"authors\":\"Abdullah Ghali, Jad Lawand, Aaron Singh, Alexander Mihas, Meghana Jami, Anthony Farhat, Lorenzo Deveza\",\"doi\":\"10.1097/BSD.0000000000001730\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study of national database.</p><p><strong>Objective: </strong>This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.</p><p><strong>Summary of background data: </strong>Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.</p><p><strong>Methods: </strong>Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.</p><p><strong>Results: </strong>In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group.</p><p><strong>Conclusions: </strong>Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-11-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001730\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001730","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery: A Propensity Matched Cohort Study.
Study design: Retrospective cohort study of national database.
Objective: This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.
Summary of background data: Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.
Methods: Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.
Results: In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group.
Conclusions: Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
