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Opioid use after adult spinal deformity surgery: A propensity-matched comparison of Japanese vs. American cohorts
Yoji Ogura1, Jeffrey L Gum2, Leah Y Carreon2, Mitsuru Yagi3, Naobumi Hosogane3, Morio Matsumoto3, Kota Watanabe3, Justin S Smith4, Christopher I Shaffrey5, Virginie F Lafage6, Douglas C Burton7, Richard A Hostin8, Michael P Kelly9, Khaled Kebaish10, Frank J Schwab6, R Shay Bess11, Christopher P Ames12
1 Norton Leatherman Spine Center, Louisville, KY, USA; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
2 Norton Leatherman Spine Center, Louisville, KY, USA
3 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
4 Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
5 Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
6 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
7 Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
8 Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
9 Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, USA
10 Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
11 Denver International Spine Clinic, Presbyterian St Luke’s Medical Center, Denver, CO, USA
12 Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
Correspondence Address:
Dr. Yoji Ogura
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202
Japan
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JOASP.JOASP_46_21
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BACKGROUND: Amidst a current US opioid epidemic, it is important to understand factors that contribute to long-term opioid use after elective surgery. In Asian countries, opioids are rarely prescribed for post-operative pain. MATERIALS AND METHODS: We propensity-matched 127 JPN to 619 US adult spinal deformity (ASD) patients based on age, sex, 3-column osteotomy, pelvic fixation, number of levels fused, and pre-operative sagittal vertical axis (SVA). Pre-operative and 2-year post-operative opioid use was determined using responses to SRS-22r Q11 and grouped into three categories (none, weekly, or daily). RESULTS: From each cohort, 34 cases were successfully matched, with no difference in baseline parameters, including baseline opioid use (P = 0.095), between the cohorts. At 2 years following surgery, 22 US (65%) vs. 31 JPN (91%) reported no opioid use; 11 US (32%) vs. 3 JPN (9%) reported daily use (P = 0.009). There was no difference in 2-year SRS-22r Self-image and Mental Health between the two groups, whereas US patients had better satisfaction (4.29 vs. 3.84, P = 0.032) but lower function scores (3.52 vs. 3.90, P = 0.029). CONCLUSION: In propensity-matched ASD cohorts, 35% of US patients were still using opioids 2 years after surgery compared with 9% of JPN patients, with the most taking opioids daily. Further studies are needed to identify sources of this variability. |
