Poor Surgery Outcomes with Narcotics

Poor Surgery Outcomes with Narcotics

Poor Surgery Outcomes with Narcotics

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In the June 2014 issue of the Journal of Bone and Joint Surgery (American edition),  Dennis Lee, MD and colleagues submitted a Paper titled  “Preoperative Opiod Use as a Predictor or Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery”.  The paper discussed an investigation performed at the Vanderbilt Medical Center in Nashville Tennesee.

583 patients,  who had spinal surgery were included in the study.  You can read the details of the study,  but preoperative parameters measured for the patients included use and amount of narcotics,  smoking history,  BMI,  Oswestry or Neck Disability Index scores,  and Zung Depression Scale scores.

The results indicate the use and the amount of preoperative opiod use (narcotics) correlated with worse outcome scores,  disability,  and depression after Spine Surgery.

As a spinal surgeon, this study is a great confirmation of what I have already seen in my practice.  Unfortunately pain is a very difficult thing to measure,  and some patients do have better tolerance than others.  Also,  pain severity can have an emotional component.  To give you an example,  when people are happy,  they just are not as painful.   When people are emotionally stressed,  the pain worsens.

Unfortunately,  there is an unhappy triad of pain,  depression and disability.   Use of narcotics often make this triad worse.  The paper did make commentary on the  exponential increase of narcotics sales from 1999 to 2010 (four fold,  according to the paper).  While the goal of the prescribers may be to help alleviate pain,  the unintended consequences  are multiple.

I have always advocated weaning dependent patients off narcotics,  or at least reducing their narcotics before a surgery.  I noticed patients who have been on chronic narcotics (over 6 months) do have the most difficulty post-op,  and have the poorer outcomes.  Some will say that is because those patients have the most pain, and the more serious problem.  I would argue that those patients may feel more pain.   That does not mean those patients have a more serious problem.   I have noticed most of the poor surgical outcomes are from patients who could not taper their pain medications.  Many claim no improvement after surgery.

It makes you wonder if surgery should be offered at all for those patients,  as the risk for spinal surgery may not be worth a predictably bad outcome.   More things to ponder.  After 21 years of practice,  I am still learning from these experiences.  I am almost tempted to stop offering surgery if patients cannot taper.   But,  then again,  I do not want to eliminate all hope for these folks.  While there are general principles that should be followed,  we still need to treat everyone one and every situation individually.

 

 

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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