Prevalence and Predictors of Opioid Use Before Spine Surgery: A Multicenter, Cross-Sectional Observational Study

Area of Science:

• Orthopedics
• Pain Management
• Public Health

Background:

• Opioids are commonly used for pain management before spine surgery in Australia.
• Concerns exist regarding the effectiveness and harms of preoperative opioid use.
• Prevalence of opioid use before spine surgery in Australia is not well understood.

Purpose of the Study:

• To assess the prevalence and predictors of preoperative opioid use in patients undergoing elective spine surgery.
• To examine geographical variations in opioid use across metropolitan, regional, and rural settings in New South Wales (NSW), Australia.

Main Methods:

• Multicenter, cross-sectional observational study.
• Involved patients scheduled for elective spine surgery across four NSW hospitals (April 2017-February 2020).
• Data collected via pre-admission questionnaires (2-6 weeks before surgery) on demographics, clinical factors, and opioid use.

Main Results:

• 50% of participants reported preoperative opioid use (95% CI 37%-63%).
• Prevalence showed minimal variation across metropolitan (49%), regional metropolitan (54%), and regional (50%) settings.
• Oxycodone (32%), codeine (20%), and tapentadol (9%) were the most common opioids.
• No significant predictors identified for location, sex, socioeconomic status, smoking, or disability, though trends suggested higher use in lower socioeconomic groups.

Conclusions:

• Half of patients undergoing elective spine surgery in NSW use opioids preoperatively, with consistent prevalence across different geographical settings.
• Further research and interventions are needed to understand and manage preoperative opioid use due to associated risks.
• Addressing preoperative opioid use may improve pain management strategies and patient outcomes following spine surgery.