title: Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery.
abstract: METHODS
  Prospective cohort.
  
  
  OBJECTIVE
  To assess whether preoperative opioid use is associated with increased perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery.
  
  
  BACKGROUND
  Previous work has demonstrated increased opioid requirements during the intraoperative and immediate postoperative period in patients with high levels of preoperative opioid use. Despite this, they remain a common agent class used for the management of pain in patients prior to spine surgery.
  
  
  METHODS
  A total of 583 patients were included. Self-reported daily opioid consumption was obtained preoperatively and converted into morphine equivalent amounts and opioid use was recorded at the 12-month postoperative time. Intraoperative and immediate postoperative opioid demand was calculated. Linear regression analyses for intraoperative and immediate postoperative opioid demand while logistic regression analyses for opioid independence at 12 months including relevant covariates such as depression and anxiety were performed.
  
  
  RESULTS
  The median preoperative morphine equivalent amount for the cohort was 8.75 mg, with 55% of patients reporting some degree of opioid use. Younger age, more invasive surgery, anxiety, and primary surgery were significantly associated with increased intraoperative opioid demand (P < 0.05). Younger age, anxiety, and greater preoperative opioid use were significantly associated with increased immediate postoperative opioid demand (P < 0.05). More invasive surgery, anxiety, revision surgery, and greater preoperative opioid use were significantly associated with a decreased incidence of opioid independence at 12 months postoperatively (P < 0.01).
  
  
  CONCLUSIONS
  Greater preoperative opioid use prior to undergoing spine surgery predicts increased immediate postoperative opioid demand and decreased incidence of postoperative opioid independence. Psychiatric diagnoses in those using preoperative opioids were predictors of continued opioid use at 12 months. Patients may benefit from preoperative counseling that emphasizes minimizing opioid use prior to undergoing spine surgery.
  
  
  METHODS
  2.
authors.affiliation: *Department of Orthopaedics, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine, Nashville, TN; and †Carolina Neurosurgery & Spine Associates, Charlotte, NC.
authors.forename: Sheyan J
authors.initials: SJ
authors.lastname: Armaghani
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Lee
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: David N
authors.initials: DN
authors.lastname: Shau
authors.forename: Harrison
authors.initials: H
authors.lastname: Kay
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000209:etiology*; D019637:Orthopedic Procedures / Q000379:methods*; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D059035:Perioperative Period; D011183:Postoperative Complications / Q000139:chemically induced; D011446:Prospective Studies; D013131:Spine / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid