1598. Implications of Drug Use Disorders on Spine Surgery
Authors: Christopher Samuel Ferari; Gennadiy Katsevman, MD; Cara Sedney (Morgantown, WV)
The opioid crisis has been declared a “public health emergency” and the CDC has included opioid overdose prevention as a top five public health challenge. Spine surgeons are treating more patients with drug abuse. The purpose of the study was to investigate the outcomes of patients with substance abuse disorder who undergo spine surgery.
A retrospective chart review was performed on patients with drug abuse who underwent non-elective spine surgery by orthopedic or neurosurgical staff from 2012 to 2017 at a level one trauma center and spine referral center. Three elective cases from that time period were excluded.
A total of 51 patients undergoing 77 surgeries were reviewed. The most common type of drug abuse was opioids (43/51 patients; 84%). Of 34 patients abusing several drugs, 29 (85%) included opioid abuse. The most common indications were infection (25/51, 49%), trauma (13/51, 25%), and myelopathy (7/51, 14%). Fusions (36/51, 71%) and irrigation and debridement surgeries (14/51, 27%) predominated. 31% (16/51) of patients had complications, the most common being hardware failure (6/51, 12%). 22% (11/51) of patients left against medical advice (AMA) and 22% (11/51) did not follow up after hospital discharge. 43% (22/51) of patients were known to be in a drug program pre-operatively versus 33% (17/51) post-operatively. 43% (22/51) were prescribed opioids in the immediate post-operative period and 43% (22/51) continued to abuse drugs post-operatively.
Patients with drug abuse history are a unique population at increased risk of peri-operative complications and inadequate post-operative 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.