Sunday, June 15, 2014

Patients taking narcotics before surgery often have poorer results from surgery

Preoperative Opioid Use as a Predictor of Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery.

These authors evaluated 583 patients having lumbar, thoracolumbar, or cervical spine surgery to treat a structural lesion. The preoperative opioid consumption was correlated with the patient-reported outcome measures at three and twelve months postoperatively.

56% (326 patients) reported some degree of opioid use before surgery. Preoperative opioid use was a significant predictor of decreased 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.

Comment: Patients that take narcotics before surgery have a substantially increased risk of a poor outcome as well as increased preoperative risks. We have previously posted a similar finding for patients having total knee arthroplasty. Another post reviews the relationship among preoperative pain, depress and the severity of arthritis. It is important to evaluate and consider the preoperative use of narcotics and the presence of depression in the decision of if and when to carry out elective surgery, even if the patient has 'a structural lesion'.


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