Impact of Alcohol, Tobacco, and Opiate Use Identified Using Preoperative Urine Toxicology and Self-reported Measures on Short-Term Outcomes Following Elective Spinal Surgery

Saturday, May 4, 2024

4:38 PM – 4:40 PM CT

Location: S405b

Presenting Author(s)

MG

Maria Guglielmo, MD (she/her/hers)

Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University
East Greenwich, RI, US

Co-Author(s)

MR

Margherita Rampichini (she/her/hers)

Undergraduate Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University

Co-Author(s)

AA

Ana Abrantes, Ph.D

Professor of Psychiatry and Human Behavior
Brown University, United States
AB

Ankush Bajaj, BS

Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
Alexander A. Chernysh, BS

Clinical Research Assistant
Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
JC

J. Barron Clancy, n/a

Undergraduate Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
Ziya L. Gokaslan, MD

Chair of Neurosurgery, Neurosurgeon-in-Chief
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System
Providence, RI, US
SK

Samika Kanekar, BS

Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
Owen P. Leary, BS (he/him/his)

Research Program Administrator
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
AS

Anna K. Shlimak, n/a

Undergraduate Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University
Falmouth, Massachusetts, United States
MS

Manjot Singh, BS

Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States
AS

Anjali Srinivasan, n/a

Undergraduate Researcher
Department of Neurosurgery, The Warren Alpert Medical School of Brown University, United States

Disclosure(s):

Maria Guglielmo, MD: No financial relationships to disclose

Ziya L. Gokaslan, MD: No financial relationships to disclose

Introduction: Prior studies have mainly utilized self-reported questionnaires to associate preoperative substance use with poor elective spinal surgery outcomes. This prospective cohort study incorporates urine toxicology with self-reported histories to evaluate alcohol, opiate, and tobacco use on post-surgical outcomes.

Methods: Adults undergoing elective spinal surgery were enrolled into the study between August 2020 and November 2023. Participants completed preoperative urine toxicology screenings and substance use questionnaires at the time of enrollment. Participants reported Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) preoperatively and up to six months postoperatively. Patients were stratified according to alcohol, tobacco, and opiate use, and and analyzed using χ², student’s t-tests, dand ANOVA analyses (p < 0.05).

Results: In total, 121 participants (mean age 58 years, 59% women, 96% white) were included. Preoperative urine toxicology and substance use screenings together demonstrated frequent opiate (32%), tobacco (30%), and alcohol (17%) use. ANOVA analysis revealed a decrease in ODI and VAS for self-reported tobacco users (ODI: pre-op=58%, 3-month=40%, 6-month=45%, p=0.007; VAS: pre-op=6.97, 3-month=4.00, 6-month=5.08, p=0.004) and non-users (ODI: pre-op=55%, 3-month=33%, 43%, p< 0.001; VAS: pre-op=6.54, 3-month=4.12, 6-month=4.92, p< 0.001). Similar improvements in ODI and VAS were observed in urine toxicology-identified alcohol users (ODI: pre-op=56.53, 3-month=26.86, 6-month=35.40, p=0.007; VAS: pre-op=7.14, 3-month=3.50, 6-month=3.50, p< 0.001) and non-users (ODI: pre-op=55.98, 3-month=37.21, 6-month=44.80, p< 0.001; VAS: pre-op=6.57, 3-month=4.20, 6-month=5.24, p< 0.001). In contrast, improvements in ODI and VAS were not observed for urine toxicology-identified opiate users (ODI: pre-op=53%, 3-month=51%, 6-month=52%, p=0.970; VAS: pre-op=6.89, 3-month=5.55, 6-month=6.27, p=0.380) relative to non-users (ODI: pre-op=53%, 3-month=30%, 6-month=41%, p< 0.001; VAS: pre-op=6.60, 3-month=3.73, 6-month=4.70, p< 0.001).

Conclusion : Although the presence of alcohol metabolites and self-reported tobacco use did not worsen pain outcomes similar to opiate use, preoperative counseling about the risks of alcohol and tobacco use should continue to be a mainstay of surgical planning.