Opioid use score does not predict adverse patient outcomes after spinal surgery

An opioid use score based on state prescription databases does not predict complications or other adverse outcomes in patients undergoing spinal surgery, reports a study in the journal Spine. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The increasingly used NarxCare narcotics score does not predict adverse outcomes or patient dissatisfaction after elective spine surgery, according to the new research by Anoop Raj Galivanche, BS, of Yale University School of Medicine and colleagues. They write, "Although there are many reasons to address preoperative patient narcotic utilization, the current study did not identify perioperative outcome/satisfaction differences based on preoperative narcotics use criteria."

Study questions routine use of previous narcotic use to predict surgical risks

The study included 346 patients undergoing elective spinal surgery at the authors' hospital over a six-month period. The hospital routinely estimated each patient's previous use of opioid pain medications with the automated NarxCare narcotic score.

The NarxCare score approximates a patient's level of previous opioid use, calculated from state prescription drug monitoring programs (PDMPs). The score accounts not only for number and dosage of opioid prescriptions, but also for the number of prescribers, number of pharmacies, and overlapping prescriptions. NarxCare scores range from 0 (no previous opioid use) to 999 (highest level of use).

On admission to the hospital for spinal surgery, nearly 80 percent of patients had a NarxCare score of greater than zero, indicating at least one recent opioid prescription. About six percent were in the highest category of NarxCare score (500 or higher). The researchers evaluated whether the preoperative NarxCare score could predict patient outcomes after spinal surgery. About four percent of patients had some type of adverse event.

After controlling for other patient characteristics, the rate of adverse outcomes was not significantly different for patients at different levels of NarxCare score. That included both minor and serious adverse events, as well as the rates of repeat surgery or repeat hospitalization. (There were no deaths within 30 days after surgery.)

NarxCare scores were also unrelated to patient satisfaction scores – increasingly viewed as an important indicator of the quality of healthcare.

Use of prescription opioid medications has increased dramatically in recent years, and these medications are frequently prescribed for patients with back pain. There is concern that previous opioid use might affect the risk of complications and other adverse outcomes of surgery, including spinal surgery. However, previous studies of this issue have reached conflicting results. State PDMPs are viewed as an important tool for responding to the ongoing opioid epidemic.

The new study finds no differences in adverse events or patient satisfaction after spinal surgery for patients with higher preoperative NarxCare scores.

In light of the fact that federal reimbursement may be affected by [patient satisfaction] scores, these findings are particularly relevant."

Anoop Raj Galivanche, BS, Yale University School of Medicine and colleagues