• Scott L Parker, Clinton J Devin, and Matthew J McGirt.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:206.

IntroductionHigh-dose or prolonged narcotic use is associated with altered pain perception and response to pain management strategies in patients with chronic pain syndromes. We set out to determine whether the amount of preoperative narcotic use for spine-related pain predicted short-term and 1-year outcomes after spine surgery.MethodsFive hundred eighty-three consecutive patients undergoing elective surgery for degenerative spine pathologies at a single institution were prospectively enrolled into a registry and followed for 1 year. Narcotic use was recorded during the patients preoperative clinic visit and converted to a daily morphine equivalent amount (MEA). SF-12, ODI/NDI, EQ-5D, return to work, and narcotic use (MEA) were recorded at 3 and 12 months after surgery. The independent association of narcotic use (MEAs) with length of stay (LOS), readmission, return to work (RTW), and 12-month patient-reported outcomes were assessed via multivariate regression analysis.ResultsFive hundred eighty-three patients underwent lumbar (60%), thoracic (11%), or cervical (29%) surgery. Mean length of hospital stay was 4.5 days, and 12.7% patients were readmitted within 90 days after surgery. Overall, pain-related disability (ODI/NDI), quality of life (SF-12), and health utility (EQ-5D) significantly (P < .001) improved after surgery. Amount of preoperative narcotic use (MEA) was independently associated with increased LOS (P < .05), increased narcotic use 3 and 12 months after surgery (P < .001), and markedly worse ODI, NDI, SF-12, and EQ-5D (P < .001) 1 year postoperatively, but was not associated with 90-day readmission or RTW. Every 10-mg increase in preoperative MEA was associated with 0.22 decrease in SF-12, 0.06 decrease in EQ-5D, and 0.5 increase in ODI or NDI 1 year postoperatively.ConclusionIncreasing levels of preoperative narcotic use were associated with worse short-term and long-term outcome after elective surgery for degenerative spine pathology. Preoperative narcotic use in MEAs may help hospitals and providers more appropriately risk stratify for surgical selection and indications. Efforts should be made to address narcotic dependence before elective spine surgery.

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