Prevalence of opioid dependence in spine surgery patients and correlation with length of stay

Mohammad Sami Walid, MD, PhD, Leon Hyer, PhD, Mohammed Ajjan, MD, Aaron C. M. Barth, Joe Sam Robinson, Jr, MD

Abstract


Objective: We addressed the prevalence of opioid dependence (OD) in spine surgery patients and its correlation with length of stay (LOS) as the most important determinant of hospital cost.
Methods: The study took place at Georgia Neurosurgical Institute and the Medical Center of Central Georgia between March 2006 and January 2007. A prospective convenience sample of 150 spine surgery patients (48 lumbar diskectomy, 60 cervical decompression and fusion, and 42 lumbar decompression and fusion [LDF]) was assembled. Patients were interviewed before surgery using a questionnaire designed in accordance with the World Health Organization and DSM-IV-TR criteria for the diagnosis of OD. The prevalence of OD was calculated based on questionnaire results. Pain intensity was quantified during admission using a 0-to-10 pain scale. We used pain intensity multiplied by duration of pain in months (WR index) as a new parameter. Lengths of stay were collected following patients’ discharge from hospital. Pearson correlation and regression analysis were performed using SPSS software.
Results: Thirty (20.00 percent) patients were opioid dependent. The prevalence was highest among LDF patients (23.81 percent), females (22.78 percent), and, to a lesser degree, Caucasians (20.87percent). There was no correlation between OD and age (r = 0.08, p > 0.1) or between OD and LOS (r = 0.09, p > 0.1). This study proved a very significant positive correlation between OD and pain intensity (r = 0.24, p < 0.01) and between OD and the WR index (r = 0.30, p < 01). On the other hand, there was a significant positive correlation between LOS and age(r= 0.42, p < 0.01), between LOS and the number of previous spine surgeries (r = 0.28, p < 01), and between LOS and duration of pain (r = 0.18, p < 0.05). Regression analysis showed that age, ethnicity, and type of surgery were the main determinants of LOS.
Conclusions: Chronic pain and prolonged use of opioids raise the prevalence of OD in spine surgery patients to 20 percent. The lack of effect of OD on LOS after surgical intervention means that efforts to decrease LOS by trying to satisfy patients’ craving for opioids will not be fruitful. Older, African-American LDF patients with a lengthy history of pain and multiple spine surgeries in the past are the most likely to stay longer in hospital.


Keywords


opioid, dependence, spine surgery, length of stay, WR index

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References


Grinstead SF: War on Drugs—War on Pain Management. Addiction Free Pain Management Web site. Available at www.addiction-free.com/chronic_pain_management_ G_addiction_war_on_drugs.htm. Accessed April 27, 2007.

Volkow N: What do we know and what don’t we know about opiate analgesic abuse? Keynote address, Wednesday, March 30, 2005. Program and abstracts of the 24th Annual Scientific Meeting of the American Pain Society, March 30 through April 2, 2005, Boston, MA.

Fishbain DA, Rosomoff HL, Rosomoff RS: Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain. 1992; 8(2): 77-85.

Hoffmann NG, Olofsson O, Salen B, et al.: Prevalence of abuse and dependency in chronic pain patients. Int J Addict. 1995; 30(8): 919-927.

Chabal C, Erjavec MK, Jacobson L, et al.: Prescription opiate abuse in chronic pain patients: Clinical criteria, incidence, and predictors. Clin J Pain. 1997; 13(2): 150-155.

Kouyanou K, Pither CE, Wessely S: Medication misuse, abuse and dependence in chronic pain patients. J Psychosom Res. 1997; 43(5): 497-504.

Reid MC, Engles-Horton LL, Weber MB, et al.: Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med. 2002; 17(3): 173-179.

World Health Organization: Narcotic & Psychotropic Drugs: Achieving Bala-nce in National Opioids Control Policy. World Health Organization, 2000. Available at www.painpolicy.wisc. edu/publicat/00whoabi/00whoabi.pdf. Accessed April 27, 2007.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition (Text Revision). Arlington, VA: American Psychiatric Publishing, 2000.

WHO Expert Committee on Addiction-Producing Drugs: Thirteenth Report. World Health Organization Technical Report Series No. 273. Geneva: World Health Organization, 1964.

World Health Organization: 5th Review of Psychoactive Substances for International Control. Geneva: World Health Organization, 1981.

National Institute on Drug Abuse: Trends in prescription drug abuse. National Institute on Drug Abuse Web site. Available at www.drugabuse.gov/ResearchReports/Prescription/ prescription5.html. Accessed April 27, 2007.

Portenoy RK: What should we tell the public to do. APS Bulletin. 1999; 9(5). Available at www.ampainsoc.org/pub/ bulletin/sep99/president.htm.

Mahowald ML, Singh JA, Majeski P: Opioid use by patients in an orthopedics spine clinic. Arthritis Rheum. 2005; 52(1): 610.

International Narcotics Control Board: Use of Essential Narcotic Drugs to Treat Pain is Inadequate, Especially in Developing Countries. INCB Annual Report, Press Release No. 6. Vienna: United Nations Information Service, 2004.




DOI: https://doi.org/10.5055/jom.2007.0050

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