Comparing different chronic preoperative opioid use definitions on outcomes after spine surgery

摘要: Abstract Background Context No consensus exists for defining chronic preoperative opioid use. Most spine studies rely solely on duration to stratify patients into risk categories. Purpose The purpose of this study is compare established definitions that contain both and dosage models duration, including the CDC Guideline Prescribing Opioids Chronic Pain, in undergoing surgery. Study Design This was a retrospective cohort used data from Tennessee Controlled Substance Monitoring Database prospective clinical single-center academic registry. Patient Sample consisted 2,373 who underwent elective surgery degenerative conditions between January 2011 February 2017 completed follow-up assessment at 12 months after Outcome Measures Postoperative use patient-reported satisfaction (NASS Satisfaction Scale), disability (Oswestry/Neck Disability Index), pain (Numeric Rating Scale) month follow-up. Methods Six different variables were created based number times prescription filled and/or daily morphine milligram equivalent one year before These defined as 1) most days > 3 (CDC), 2) continuous ≥ 6 (Schoenfeld), 3) >4,500 mg least 9 (Svendsen wide), 4) >9,000 intermediary), 5) >18,000 strict), 6) low-dose (1-36 >91 days), medium-dose (36-120 high-dose (>120 days) (Edlund). Multivariable regression yielding C-index R2 values by postoperative outcomes, adjusting type Results reported 470 725 (19.8% 30.6%) patients, depending definition. Edlund definition, accounting dosage, had highest predictive ability (77.5%), followed Schoenfeld (75.7%), (72.6%), Svendsen (59.9% 72.5%) definitions. A combined definition post-hoc analysis, included cut-offs, performed best overall with 78.4%. Both explained similar amounts variance satisfaction, disability, (4.2% 8.5%). demonstrated poorer performance outcomes (1.4% 7.2%). Conclusions recommended identifying When unavailable, reasonable choice ability. For either or recommended. Future work should consider combing cutoffs,