Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients.

Title

Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients.

Creator

Karhade Aditya V; Chaudhary Muhammad Ali; Bono Christopher M; Kang James D; Schwab Joseph H; Schoenfeld Andrew J

Publisher

The Spine Journal: Official Journal Of The North American Spine Society

Date

2019
2019-10

Description

BACKGROUND CONTEXT: The opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort. PURPOSE: We sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts. STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURES: Sustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery. METHODS: The performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use. RESULTS: Among 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0-53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1-4.2) in the low-risk group (scores <30), 17.2% (15.6-18.7) in the intermediate-risk group (scores 30-60), and 46.0% (36.2-55.9) in the high-risk group (scores >60). CONCLUSIONS: We have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.

Subject

Opioid dependence; Spine surgery; Prediction; Anterior cervical discectomy and fusion; Lumbar disc herniation; Risk score

Identifier

PMID: 31078697

Format

Journal Article

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

1666-1671

Issue

10

Volume

19

ISSN

1878-1632 1529-9430

Citation

Karhade Aditya V; Chaudhary Muhammad Ali; Bono Christopher M; Kang James D; Schwab Joseph H; Schoenfeld Andrew J, “Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients.,” NEOMED Bibliography Database, accessed March 1, 2021, https://neomed.omeka.net/items/show/10806.

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