Comparison of the stopping opioids after surgery (SOS) score to preoperative morphine milligram equivalents (MME) for prediction of opioid prescribing after lumbar spine surgery.
Creator
Karhade AV; Schwab JH; Harris MB; Schoenfeld AJ
Publisher
The Spine Journal
Date
2020
2020-06
Description
BACKGROUND CONTEXT: Reliable estimation of the likelihood for prolonged postoperative opioid use may aid targeted interventions for high-risk patients. Previous studies have recommended differing methodologies for prediction of sustained postoperative opioid use. PURPOSE: To compare the performance of the Stopping Opioids after Surgery (SOS) score and preoperative morphine milligram equivalents (MME) for postoperative opioid prescription exposure in a contemporary cohort of lumbar surgery patients. PATIENT SAMPLE: Adult patients undergoing posterior decompression with or without fusion for degenerative lumbar conditions between January 31(st), 2016 and May 31(st), 2019. STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURES: The primary outcome was sustained postoperative prescription opioid exposure at 3-months and 6-months. Reoperations and readmissions were considered secondarily. METHODS: SOS score and MME were assigned to patients based on data from their pre-operative surgical evaluation. Performance for both measures was assessed for all outcomes by discrimination, including c-statistic and receiver-operating curve analysis. Calibration of the low, medium and high-risk strata with the observed rates of postoperative adverse events were examined. RESULTS: Overall, 4165 patients were included in this study. Pre-operative prevalence of prescription opioid use was 31%. Rates of postoperative opioid prescriptions at 3-months and 6-months, were 3.3% (n = 136) and 1.5% (n = 61). The c-statistics of preoperative oral MME and SOS score for 3-month sustained opioid prescriptions were 0.64 and 0.78, respectively. The c-statistics of preoperative oral MME and SOS score for 6-month sustained opioid prescriptions were 0.64 and 0.82, respectively. C-statistics of preoperative oral MME and SOS score were much lower for reoperation and readmission, although SOS score outperformed MME for both outcomes. CONCLUSION: The SOS score clinically outperformed oral MME as a predictive measure for outcomes following lumbar spine surgery. The SOS score may be valuable for identifying individuals at high-risk for sustained prescription opioid use and associated adverse events following spine surgery.
Subject
lumbar spine surgery; morphine milliequivalents; opioid dependence; prescription opioid use; risk score; Stopping Opioids after Surgery (SOS) score