KMID : 1189320200140050663
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Asian Spine Journal 2020 Volume.14 No. 5 p.663 ~ p.672
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Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users
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Reisener Marie-Jacqueline
Hughes Alexander P. Schadler Paul Forman Alexa Sax Oliver C. Shue Jennifer Cammisa Frank P. Sama Andrew A. Girardi Federico P. Mancuso Carol A.
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Abstract
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Study Design: Matched cohort study.
Purpose: To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids.
Overview of Literature: Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients¡¯ expectations of lumbar surgery outcomes remain to be rigorously assessed.
Methods: A total of 77 opioid users grouped according to dose and duration (54 ¡°higher users,¡± 30 ¡°lower users¡±) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. ¡°Greater expectations¡± was defined as a higher survey score (possible range, 0?100) based on the number of items expected and degree of improvement expected.
Results: The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, p=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, p=0.01) and compared with higher users (70, p=0.01). In multivariable analysis, ¡°greater expectations¡± was independently associated with having had chiropractic care (p=0.03), being more disabled (p=0.002), and being a lower-dose opioid user (p=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, p=0.003).
Conclusions: Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.
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KEYWORD
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Expectations, Lumbar surgery, Opioids, Lower-back pain
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