Does preoperative narcotic use adversely affect outcomes and complications after spinal deformity surgery? A comparison of nonnarcotic- with narcotic-using groups.
BACKGROUND
The role of preoperative (preop) narcotic use and its influence on outcomes after spinal deformity surgery are unknown. It is important to determine which patient factors and comorbidities can affect the success of spinal deformity surgery, a challenging surgery with high rates of complications at baseline.


OBJECTIVE
To evaluate if preop narcotic use persists after spinal deformity surgery and whether the outcomes are adversely affected by preop narcotic use.


METHODS
Retrospective evaluation of prospectively collected data.


METHODS
Two hundred fifty-three adult patients (230 females/23 males) undergoing primary spinal deformity surgery were enrolled from 2000 to 2009.


METHODS
Preoperative and postoperative (postop) narcotic use and changes in Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) pain, and SRS total scores.


METHODS
Preoperative, 2-year postop, and latest follow-up pain medication use were collected along with ODI, SRS pain, and SRS scores. Preoperative insurance status, surgical and hospitalization demographics, and complications were collected. All patients had a minimum 2-year follow-up (average 47.4 months).


RESULTS
One hundred sixty-eight nonnarcotic (NoNarc) patients were taking no pain meds or only nonsteroidal anti-inflammatories preoperatively. Eighty-five patients were taking mild/moderate/heavy narcotics before surgery. The average age was 48.2 years for the NoNarc group versus 53.6 years for the Narc group (p<.005). There were significantly more patients with degenerative than adult scoliosis in the Narc group (47 vs. 28, p<.001; mild 19 vs. 24, p<.02; moderate 6 vs. 14, p<.0003; heavy 3 vs. 10, p<.0002). Insurance status (private/Medicare/Medicaid) was similar between the groups (p=.39). At latest follow-up, 137/156 (88%) prior NoNarc patients were still not taking narcotics whereas 48/79 (61%) prior narcotic patients were now off narcotics (p<.001). Significant postop improvements were seen in Narc versus NoNarc groups with regard to ODI (26-15 vs. 44-30.3, p<.001), SRS pain (3.36-3.9 vs. 2.3-3.38, p<.001), and overall SRS outcome (3.36-4 vs. 2.78-3.68, p<.001) scores. A comparison of change in outcome scores between the two groups showed a higher improvement in SRS pain scores for the Narc versus NoNarc group (p<.001).


CONCLUSIONS
In adults with degenerative scoliosis taking narcotics a significant decrease in pain medication use was noted after surgery. All outcome scores significantly improved postop in both groups. However, the Narc group had significantly greater improvements in SRS pain scores versus the NoNarc group.
Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
Addisu
A
Mesfin
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA. Electronic address: lenkel@wudosis.wustl.edu.
Lawrence G
LG
Lenke
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA.
Keith H
KH
Bridwell
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA.
Usman
U
Akhtar
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA.
Jennifer M
JM
Jupitz
Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Jeremy L
JL
Fogelson
Florida Spine Specialists, 6000 N. Federal Hwy, Fort Lauderdale, FL 33308, USA.
Stuart H
SH
Hershman
Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
Han J
HJ
Kim
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110, USA.
Linda A
LA
Koester
D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D014481:United States
D009294:Narcotics
Adults; Degenerative scoliosis; Narcotic use; ODI; Outcomes; Spinal deformity