Assessing a dose-response relationship: Preoperative opioid daily MME and duration on lumbar spine surgery patient-reported outcomes

Objective

It has been posited that preoperative opioid use can be a detrimental factor in prognosis, although its association with patient-reported outcomes (PROs) remains unclear. We aimed to examine complication rates, satisfaction, return to work, and improvement in back/leg pain with Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) considering preoperative opioid use utilizing a national, prospective registry.

Methods

From 40,321 lumbar spine surgery patients, chronicity of preoperative use was defined as opioid-naive (no use), new (<6 wk), short-term (6 wk-3 mo), intermediate (3–6 mo), long-term (6 mo-1 yr), and chronic use (>1 yr). Daily use was defined according to an established morphine milliequivalent (MME) threshold. Multivariate regression models were constructed.

Results

Long-term use was associated with lower improvement in VAS for back pain at 3- (p < .005) and 12-months (p = 0.026), as well as for leg pain at 12-months (p = 0.012). There were lower odds of achieving VAS back pain (p = .021) and ODI (p = .032) MCID at 3-months for those with high daily MME, though 12-month outcomes were comparable. All preoperative opioid use durations and MME levels were associated with higher postoperative use (p < .005), yet return to work rates and satisfaction were comparable.

Conclusions

Chronic preoperative opioid use is associated with worse PROs yet satisfaction, complication rates, and return to work were largely unaffected. Daily opioid burden in MME showed little impact on long-term outcomes. Most patients with preoperative opioid use benefit from lumbar spine surgery, yet preoperative opioid counseling remains necessary.