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

Spine surgery is performed on 45 000 Australians annually, and opioids are frequently used for pain management before spine surgery, although concerns about their effectiveness and harms persist. Evidence suggests preoperative opioid use is associated with poorer surgical outcomes, yet the prevalence of opioid use before spine surgery in Australia remains unclear. This study aimed to assess the prevalence and predictors of preoperative opioid use among patients undergoing elective spine surgery across geographical settings in NSW, Australia. A multicenter, cross-sectional observational study was conducted with patients scheduled for elective spine surgery at four hospitals representing metropolitan, regional, and rural settings from April 2017 to February 2020. Participants completed a pre-admission questionnaire 2-6 weeks before surgery, providing demographic, clinical, and opioid use data. Preoperative opioid use was reported by 50% (33/66; 95% CI 37%-63%) of participants, with minimal variation across metropolitan (49%), regional metropolitan (54%), and regional hospitals (50%). The most frequently used opioids were oxycodone (32%), codeine (20%), and tapentadol (9%). No significant predictors of opioid use were identified in relation to location, sex, socioeconomic status, smoking, or disability, although trends suggested a higher likelihood of opioid use among patients from lower socioeconomic backgrounds. These findings indicate that 50% of patients use opioids before elective spine surgery, with minimal geographical variation. Given the risks of opioids, efforts to better understand and manage opioid use before spine surgery are warranted. Addressing this issue could lead to more effective pain management strategies and improved patient outcomes.