Abstract

Assess opioid usage in surgical and non-surgical patients with lumbar disc herniation receiving different treatment approaches and timing.Individuals with newly diagnosed lumbar intervertebral disc without myelopathy were queried from Optum Clinformatics DataMart. Patients were categorized into 3 cohorts: nonsurgical, early surgery, and late surgery. Early surgery cohort patients had surgery within 30-days post-diagnosis; late surgery cohort patients had surgery after 30 days but before 1-year post-diagnosis. The index date was defined as the diagnosis date for nonsurgical patients, and the initial surgery date for surgical patients. The primary outcome was the average daily opioid morphine milligram equivalent (MME) prescribed. Additional outcomes included the percentage of opioid-using patients and cumulative opioid burden.A total of 573,082 patients met inclusion criteria: 533,226 patients received nonsurgical treatments, 22,312 patients received early surgery, and 17,544 patients received late surgery. Both surgical cohorts experienced a "post-surgical hump" of opioid usage, which then sharply declined and gradually plateaued, with daily opioid MME consistently lower in the early as opposed to late surgery cohort. The early surgery cohort also consistently had a lower prevalence of opioid-using patients than the late surgery cohort. Patients receiving nonsurgical demonstrated the highest one-year post-index cumulative opioid burden, and the early surgery cohort consistently had lower cumulative opioid MME than the late surgery cohort.Early surgery in lumbar disc herniation patients is associated with lower long-term average daily MME, incidence of opioid use, and one-year cumulative MME burden compared to nonsurgical and late surgery treatment approaches.

View details for DOI 10.1016/j.wneu.2023.02.029

View details for PubMedID 36775237