Implications of Drug Use Disorders on Spine Surgery.

BACKGROUND

The opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUD).

OBJECTIVE

Investigate the outcomes of patients with SUD who undergo spine surgery.

METHODS

A retrospective chart review was performed on patients with SUD who underwent non-elective spine surgery by orthopedic or neurosurgical staff from 2012-2017 at a level one trauma center and spine referral center. Three elective cases were excluded.

RESULTS

A total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 multi-substance use patients (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice (AMA) and 22% (11/49) did not follow-up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program pre-operatively versus 39% (19/49) post-operatively. Sixty-five percent (32/49) were prescribed opioids in the immediate post-operative period and 47% (23/49) continued to abuse drugs post-operatively.

CONCLUSION

Patients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional peri-operative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.