Addressing smoking and opioid use prior to spine surgery could reduce dependence after discharge

With as many as 38% of patients nationally still on opioids one year after elective spine surgery, the researchers sought to identify drivers of in-hospital opioid consumption as a path toward decreasing subsequent opioid dependence.

In-hospital consumption of opioids after elective spine surgery is driven chiefly by age, previous opioid use, smoking and the number of levels fused, according to a recent study published in the Journal of Spine Surgery.

With as many as 38% of patients nationally still on opioids one year after elective spine surgery, the researchers sought to identify drivers of in-hospital opioid consumption as a path toward decreasing subsequent opioid dependence.

The researchers at Norton Leatherman Spine studied in-hospital opioid consumption in patients undergoing one- to two-level instrumented lumbar fusions. Among 1,502 patients, the mean cumulative morphine milligram equivalents by postoperative day four was 251.5. Prior studies suggest that higher opioid doses may increase risk for continued opioid use without affording better post-op pain control.  In this study, statistical analysis indicated four primary drivers of continued opioid use; younger age, preoperative opioid use, current smokers and more levels fused.

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“Use of preoperative opioids and smoking are modifiable risk factors for higher in-hospital opioid consumption and can be targets for intervention prior to surgery in order to decrease in-hospital opioid use,” the authors concluded.

The study, “Drivers of In-hospital Opioid Consumption in Patients Undergoing Lumbar Fusion Surgery,” was published in the March 2021 issue of the Journal of Spine Surgery. The study’s authors from Norton Leatherman Spine included:

Jeffrey L. Gum, M.D.

Charles H. Crawford III, M.D.

Mladen Djurasovic, M.D.

Kirk Owens II, M.D.

John R. Dimar II, M.D.

Steven D. Glassman, M.D.

Leah Y. Carreon, M.D.


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