The impact of preoperative motor weakness on postoperative opioid use after ACDF

Hannah A Levy; Brian A Karamian; Jeffrey Henstenburg; Joseph Larwa; Jose A Canseco; Brett Haislup; Michael Chang; Parthik Patel; Kris E Radcliff; Barrett I Woods; Mark F Kurd; Alan S Hilibrand; Christopher K Kepler; Alexander R Vaccaro; Gregory D Schroeder

doi:10.1016/j.jor.2021.06.003

The impact of preoperative motor weakness on postoperative opioid use after ACDF

J Orthop. 2021 Jun 30:26:23-28. doi: 10.1016/j.jor.2021.06.003. eCollection 2021 Jul-Aug.

Authors

Affiliation

¹ Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

This study aims to determine if preoperative weakness is an isolated risk factor for prolonged postoperative opioid use after anterior cervical discectomy and fusion (ACDF). Patients with preoperative weakness were significantly more likely to have prolonged and inappropriate opioid use and have a single prescription mean morphine equivalent (MME) ≥ 200. Logistic regression isolated preoperative weakness, opioid tolerance, depression, and VAS Neck pain as independent predictors of extended opioid use. High postoperative opioid dose (MME ≥ 90) correlated with opioid tolerance, younger age, male sex, greater CCI, prior cervical surgery, and preoperative VAS Neck pain on regression.

Keywords: ACDF; Charlson comorbidity index, CCI; Motor weakness; Narcotics; Opioid; Pennsylvania prescription drug monitoring program, PDMP; Risk factors; Spine surgery; anterior cervical discectomy and fusion, ACDF; body mass index, BMI; health-related quality of life, HRQOL; manual muscle testing, MMT; mean morphine equivalent, MME; odds ratio, OR; visual analogue scale, VAS.