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Association Between Opioid Utilization and Patient Reported Outcome Measures Following Lumbar Spine Surgery – Lumbar Spinal Stenosis

The article explores the impact of chronic preoperative opioid use on Patient-Reported Outcomes Measurement Information System (PROMIS) survey scores in patients undergoing lumbar spine surgery. The study involved 227 patients, of which 25.11% were chronic opioid users. The results showed that chronic opioid users had worse baseline PROMIS scores compared to non-chronic users, but they displayed significant postoperative improvement in multiple domains. This suggests that patients with chronic opioid use can benefit greatly from surgical intervention, providing valuable information for physicians to better manage patient expectations

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CONCLUSION: Patients with chronic opioid use status have worse baseline PROMIS scores compared with patients who had non-chronic 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.

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Spine J. 2024 Feb 14:S1529-9430(24)00075-5. doi: 10.1016/j.spinee.2024.02.004. Online ahead of print.ABSTRACTBACKGROUND 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,

Spine J. 2024 Feb 14:S1529-9430(24)00075-5. doi: 10.1016/j.spinee.2024.02.004. Online ahead of print.

ABSTRACT

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 03/2019 and 11/2021, 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 non-chronic 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 two cohorts at 1 year follow-up in PROMIS Depression (-5.04±7.88 vs. -2.49±8.73, p=0.042), PF (6.25±7.11 vs. 9.03±9.04, p=0.019), and PI (-7.40±7.37 vs. -10.58±9.87, p=0.011) and 2 year follow-up in PROMIS PF (5.58±6.84 vs. 7.99±9.64, p=0.041) and PI (-6.71±8.32 vs. -9.62±10.06, p=0.032). 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 non-chronic 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.

PMID:38365008 | DOI:10.1016/j.spinee.2024.02.004

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Association Between Opioid Utilization and Patient Reported Outcome Measures Following Lumbar Spine Surgery

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Spine J. 2024 Feb 14:S1529-9430(24)00075-5. doi: 10.1016/j.spinee.2024.02.004. Online ahead of print.ABSTRACTBACKGROUND 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

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