title: Preoperative Opioid Use as a Predictor of Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery.
abstract: BACKGROUND
  Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. The objective of this investigation was to assess whether preoperative opioid use predicts worse self-reported outcomes in patients undergoing spine surgery.
  
  
  METHODS
  Five hundred and eighty-three patients undergoing lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion were included in this prospective cohort study. Self-reported preoperative opioid consumption data were obtained at the preoperative visit and were converted to the corresponding daily morphine equivalent amount. Patient-reported outcome measures were assessed at three and twelve months postoperatively via the 12-Item Short-Form Health Survey and the EuroQol-5D questionnaire, as well as, when appropriate, the Oswestry Disability Index and the Neck Disability Index. Separate multivariable linear regression analyses were then performed.
  
  
  RESULTS
  At the preoperative evaluation, of the 583 patients, 56% (326 patients) reported some degree of opioid use. Multivariable analyses controlling for age, sex, diabetes, smoking, surgery invasiveness, revision surgery, preoperative Modified Somatic Perception Questionnaire score, preoperative Zung Depression Scale score, and baseline outcome score found that increased preoperative opioid use was a significant predictor (p < 0.05) of decreased 12-Item Short-Form Health Survey and EuroQol-5D scores, as well as of increased Oswestry Disability Index and Neck Disability Index scores at three and twelve months postoperatively. Every 10-mg increase in daily morphine equivalent amount taken preoperatively was associated with a 0.03 decrease in the 12-Item Short-Form Health Survey physical component summary and mental component summary scores, a 0.01 decrease in the EuroQol-5D score, and a 0.5 increase in the Oswestry Disability Index and Neck Disability Index score at twelve months postoperatively. Higher preoperative Modified Somatic Perception Questionnaire and Zung Depression Scale scores were also significant negative predictors (p < 0.05).
  
  
  CONCLUSIONS
  Increased preoperative opioid consumption, Modified Somatic Perception Questionnaire score, and Zung Depression Scale score prior to undergoing spine surgery predicted worse patient-reported outcomes. This suggests the potential benefit of psychological and opioid screening with a multidisciplinary approach that includes weaning of opioid use in the preoperative period and close opioid monitoring postoperatively.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Dennis
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Sheyan
authors.initials: S
authors.lastname: Armaghani
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Jesse
authors.initials: J
authors.lastname: Bible
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: David
authors.initials: D
authors.lastname: Shau
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Harrison
authors.initials: H
authors.lastname: Kay
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Carolina Neurosurgery & Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Department of Orthopaedics & Rehabilitation, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232. E-mail address for D. Lee: dennis.lee@vanderbilt.edu. E-mail address for C. Devin: clinton.j.devin@vanderbilt.edu.
authors.forename: Clinton
authors.initials: C
authors.lastname: Devin
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D057566:Self Report; D013122:Spinal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid