Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users.
Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users.
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DOI：
10.31616/asj.2020.0114
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发表时间：
2020-10
影响因子：
2.3
通讯作者：
Mancuso CA
中科院分区：
文献类型：
--
作者：
Reisener MJ;Hughes AP;Schadler P;Forman A;Sax OC;Shue J;Cammisa FP;Sama AA;Girardi FP;Mancuso CA
匹配队列研究。比较和描述阿片类药物使用对服用阿片类药物患者和未服用阿片类药物患者腰椎手术结局预期的影响。长期使用阿片类药物在腰椎手术患者中很常见。接受择期腰椎手术的决定受到预期手术结局的影响。然而，阿片类药物对患者腰椎手术结果预期的影响仍有待严格评估。根据剂量和持续时间分组的77名阿片类药物使用者（54名“较高使用者”，30名“较低使用者”）与154名非阿片类药物使用者（基于年龄，性别，婚姻状况，脊椎按摩护理，残疾和诊断）以2：1匹配。所有患者完成了一项经验证的20项期望调查，测量了症状、功能、心理健康和预期未来脊柱状况的预期改善。“更高的期望”被定义为根据预期的项目数量和预期的改进程度获得更高的调查分数（可能的范围，0-100）。所有阿片类药物使用者和所有非使用者的平均期望调查评分相似（73 vs. 70，p=0.18）。然而，与匹配的非使用者（69，p=0.01）和较高使用者（70，p= 0.01）相比，较低使用者（79）的评分不同。在多变量分析中，“更高的期望”与脊椎护理（p=0.03），残疾程度（p=0.002）和低剂量阿片类药物使用者（p=0.03）独立相关。与较高的用户相比，较低的用户也更有可能期望在手术后2年不需要止痛药（47%对83%，p=0.003）。患者对腰椎手术的期望与不同的人口统计学和临床变量相关。与非使用者相比，较低剂量和较短持续时间的阿片类药物使用与期望更多项目和期望更完全的改善相关。此外，与较高的使用者相比，较低的类阿片使用者有更高的总体期望。
Matched cohort study. To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids. Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed. A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected. The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, p=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, p=0.01) and compared with higher users (70, p=0.01). In multivariable analysis, “greater expectations” was independently associated with having had chiropractic care (p=0.03), being more disabled (p=0.002), and being a lower-dose opioid user (p=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, p=0.003). Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.