title: Increased Preoperative Narcotic Use and Its Association With Postoperative Complications and Length of Hospital Stay in Patients Undergoing Spine Surgery.
abstract: METHODS
  Prospective cohort analysis.
  
  
  OBJECTIVE
  To assess the effect of preoperative narcotic use on the incidence of 30- and 90-day postoperative complications, as well as length of hospital stay (LOS) in patients undergoing spine surgery.
  
  
  BACKGROUND
  Previous work has associated an increased incidence of complications and length of stay following surgery in patients with increased preoperative narcotic use. Despite this and recent national attention highlighting the negative effects of narcotics, they remain commonly used for the management of pain in patients undergoing spine surgery.
  
  
  METHODS
  A total of 583 patients undergoing spine surgery for a structural lesion were evaluated. Self-reported preoperative narcotic consumption was obtained and converted to morphine equivalents at the initial preoperative visit. LOS was recorded upon discharge and presence/type of a postoperative complication within 30/90 days was obtained. A multivariable logistic and linear regression analysis was performed for the incidence of complications and length of stay controlling for clinically important covariates.
  
  
  RESULTS
  Narcotic use was not associated with 30- or 90-day complications; however, smoking status was significantly associated with 30-day complications. Increased preoperative narcotic use was significantly associated with increased LOS, as was age, type of surgery, and depression.
  
  
  CONCLUSIONS
  Increased preoperative narcotic use and depression are associated with increased LOS in patients undergoing spine surgery. We calculated that for every 100 morphine equivalents a patient is taking preoperatively; their stay is extended 1.1 days. Narcotic use was not associated with 30- or 90-day postoperative complications. As reimbursement is bundled before surgery, providing interventions for patients with treatable causes for increased length of stay can save cost overall.
authors.affiliation: *Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center†Department of Orthopaedics and Rehabilitation, Vanderbilt Medical School, Nashville, TN‡Carolina Neurosurgery and 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: 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: D003710:Demography; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009294:Narcotics / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D013131:Spine / Q000601:surgery*
chemical_list: D009294:Narcotics