title: Preoperative narcotic utilization: accuracy of patient self-reporting and its association with postoperative narcotic consumption.
abstract: OBJECTIVE
  Little is known about the accuracy of reporting of preoperative narcotic utilization in spinal surgery. As such, the purpose of this study is to compare postoperative narcotic consumption between preoperative narcotic utilizers who do and do not accurately self-report preoperative utilization.
  
  
  METHODS
  Patients who underwent anterior cervical discectomy and fusion, minimally invasive lumbar discectomy, or minimally invasive transforaminal lumbar interbody fusion procedures between 2013 and 2014 were prospectively identified. The accuracy of self-reporting preoperative narcotic consumption was determined utilizing the Illinois Prescription Monitoring Program. Total inpatient narcotic consumption during postoperative Days 0 and 1 was compared according to the demographics and preoperative narcotic reporting accuracy. Similarly, the proportion of patients who continued to be dependent on narcotic medications at each postoperative visit was compared according to the demographics and preoperative narcotic reporting accuracy.
  
  
  RESULTS
  A total of 195 patients met the inclusion criteria. Of these, 25% did not use narcotics preoperatively, while 47% and 28% did do so with accurate and inaccurate reporting, respectively. Patients who used narcotics preoperatively were more likely to demonstrate elevated inpatient narcotic consumption (adjusted RR 5.3; 95% CI 1.4-20.1; p = 0.013). However, such patients were no more or less likely to be dependent on narcotic medications at the first (p = 0.618) or second (p = 0.798) postoperative visit. Among patients who used narcotics preoperatively, no differences were demonstrated in terms of inpatient narcotic consumption (p = 0.182) or narcotic dependence following the first (p = 0.982) or second (p = 0.866) postoperative visit according to the self-reported accuracy of preoperative narcotic utilization. The only preoperative factors that were independently associated with elevated inpatient narcotic consumption were workers' compensation status and procedure type. The only preoperative factors that were independently associated with narcotic dependence at the first postoperative visit were female sex, workers' compensation status, and procedure type. The only preoperative factor that was independently associated with narcotic dependence at the second postoperative visit was procedure type.
  
  
  CONCLUSIONS
  The findings suggest that determining the actual preoperative narcotic utilization in patients who undergo spine surgery may help optimize postoperative pain management. Approximately 75% of patients used narcotics preoperatively. Patients who used narcotics preoperatively demonstrated significantly higher inpatient narcotic consumption, but this difference did not persist following discharge. Finally, postoperative narcotic consumption (inpatient and following discharge) was independent of the self-reported accuracy of preoperative narcotic utilization. Taken together, these findings suggest that corroboration between the patient's self-reported preoperative narcotic utilization and other sources of information (e.g., family members and narcotic registries) may be clinically valuable with respect to minimizing narcotic requirements, thereby potentially improving the management of postoperative pain.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Tabaraee
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
authors.forename: Khaled
authors.initials: K
authors.lastname: Aboushaala
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
authors.forename: Islam M
authors.initials: IM
authors.lastname: Elboghdady
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois; and.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009294:Narcotics / Q000627:therapeutic use*; D019635:Neurosurgical Procedures; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D012189:Retrospective Studies; D057566:Self Report; D013123:Spinal Fusion / Q000379:methods; D055815:Young Adult
chemical_list: D009294:Narcotics
keywords: ACDF = anterior cervical discectomy and fusion; BMI = body mass index; CCI = Charlson Comorbidity Index; ILPMP = Illinois Prescription Monitoring Program; Illinois; OME = oral morphine equivalent; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; accuracy; narcotic utilization; prescription monitoring; reporting; spine surgery