方法:前瞻性多中心数据库事后分析。
目的:阿片类药物通常用于治疗疼痛性脊柱疾病,以缓解疼痛并改善功能,在脊柱手术之前和之后。在当前的阿片类药物流行中,提供者了解阿片类药物使用的影响及其与患者报告结局的关系非常重要.这项研究的目的是评估围绕ASD的术前/术后阿片类药物的消耗,并评估接受脊柱畸形手术的老年患者的患者报告的疼痛结果。
方法:纳入来自12个国际中心的年龄≥60岁接受至少5级脊柱融合术和至少2年随访的患者。在基线和手术后2年时,使用腰腿痛的数字评定量表(NRS-B;NRS-L)收集患者报告的结果评分。阿片类药物的使用,根据病例报告表格上的特定问题和SRS-22r问卷中的问题11定义,在基线和2年随访时进行评估。
结果:在符合纳入标准的219例患者中,179(81.7%)有2年阿片类药物使用数据。在基线(n=75,34.2%)和手术后2年(n=55,30.7%)报告使用阿片类药物的患者百分比相似(P=0.23)。然而,在最后一次随访中,39%的基线阿片类药物使用者(Opi)不再服用阿片类药物,而14%的初始非使用者(No-Opi)报告使用阿片类药物。亚洲人群区域术前和术后阿片类药物使用率分别为5.8%和7.7%,欧洲的58.3%和53.1%,北美患者分别为50.5%和40.2%,分别。基线阿片类药物使用者报告的术前背痛多于无Opi组(7.0vs5.7,P=.001),而NRS-腿部疼痛评分具有可比性(4.8vs4,P=.159)。同样,在最后的随访中,Opi组患者的NRS-B评分高于非Opi组患者(3.2vs2.3,P=.012),但NRS-腿部疼痛评分无差异(2.2vs2.4,P=0.632)。
结论:在这项研究中,全世界近三分之一的ASD手术患者在术前和术后均服用阿片类药物.有明显的国际差异,亚洲患者的使用率要低得多,暗示了一种文化影响。尽管阿片类药物使用者和非使用者都从手术中受益,术前使用阿片类药物与基线时持续2年随访的背痛显著相关,以及持续的术后阿片类药物需求。
METHODS: Prospective multicenter database post-hoc analysis.
OBJECTIVE: Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes. The purpose of this study was to evaluate pre-/postoperative opioid consumption surrounding ASD and assess patient-reported pain outcomes in older patients undergoing surgery for spinal deformity.
METHODS: Patients ≥60 years of age from 12 international centers undergoing spinal fusion of at least 5 levels and a minimum 2-year follow-up were included. Patient-reported outcome scores were collected using the Numeric Rating Scale for back and leg pain (NRS-B; NRS-L) at baseline and at 2 years following surgery. Opioid use, defined based on a specific question on case report forms and question 11 from the SRS-22r questionnaire, was assessed at baseline and at 2-year follow-up.
RESULTS: Of the 219 patients who met inclusion criteria, 179 (81.7%) had 2-year data on opioid use. The percentages of patients reporting opioid use at baseline (n = 75, 34.2%) and 2 years after surgery (n = 55, 30.7%) were similar (P = .23). However, at last follow-up 39% of baseline opioid users (Opi) were no longer taking opioids, while 14% of initial non-users (No-Opi) reported opioid use. Regional pre- and postoperative opioid use was 5.8% and 7.7% in the Asian population, 58.3% and 53.1% in the European, and 50.5% and 40.2% in North American patients, respectively. Baseline opioid users reported more preoperative back pain than the No-Opi group (7.0 vs 5.7, P = .001), while NRS-Leg pain scores were comparable (4.8 vs 4, P = .159). Similarly, at last follow-up, patients in the Opi group had greater NRS-B scores than Non-Opi patients (3.2 vs 2.3, P = .012), but no differences in NRS-Leg pain scores (2.2 vs 2.4, P = .632) were observed.
CONCLUSIONS: In this study, almost one-third of surgical ASD patients were consuming opioids both pre- and postoperatively world-wide. There were marked international variations, with patients from Asia having a much lower usage rate, suggesting a cultural influence. Despite both opioid users and nonusers benefitting from surgery, preoperative opioid use was strongly associated with significantly more back pain at baseline that persisted at 2-year follow up, as well as persistent postoperative opioid needs.