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The Impact of Preoperative Nicotine Use in the Development of Opioid Use Disorder Following Lumbar Disc Discectomy
Jinpyo Hong1, Andrew Kim1, Zachary Freedman2
1Neurological Surgery, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.
Background:
Opioid prescriptions are highly prevalent for patients undergoing lumbar discectomy procedures for pain control. Management is further complicated in patients with preoperative substance abuse, a known risk factor for addiction. The purpose of this study is to determine whether preoperative nicotine use influences the risk of developing opioid use disorder (OUD) following lumbar discectomy procedures.
Methods:
The TriNetX Research database was retrospectively analyzed to identify subjects in the U.S. who underwent lumbar discectomy and received postoperative opioid treatment within two weeks of the procedure. Individuals were then divided into two cohorts based on the presence of nicotine dependence prior to surgery (nicotine dependent vs. non-nicotine dependent) and propensity score matched on known risk factors of addiction, with a matched cohort sample size of 18,305. Development of OUD was then assessed at one, three, six, 12, and 36 months after surgery. The secondary surgical outcomes, including hematoma and surgical site infection (SSI), were also examined. Additional outcomes included myocardial infarction (MI), pulmonary embolism (PE)/venous thromboembolism (VTE), and emergency department (ED) visits one year after surgery.
Results:
Nicotine dependence was associated with an increased diagnosis of OUD at all time points (36 months: OR 2.533; CI 2.194-2.923). Preoperative nicotine use was also associated with increased risk of SSI (OR 1.218; 1.033-1.437). Myocardial infarction (12 months: OR 1.698; 1.371-2.102) and ED visits (12 months: OR 1.506; 1.433-1.583) were significantly increased at all time points. There was no significant difference between cohorts in developing hematoma or PE/deep vein thrombosis (DVT).
Conclusion:
Preoperative nicotine dependence increases the risk of OUD, SSI, MI, and ED visits following lumbar discectomy procedures. Future prospective studies examining the impact of patient education and preoperative smoking cessation programs are warranted to evaluate their impact on postoperative outcomes.
