interim report by the Commission on Combating Drug Addiction and the Opioid Crisis. The report goes on to say that, since 1999, the number of opioid overdoses in the U.S. has quadrupled. Over that same period, the amount of prescription opioids sold has quadrupled as well. With a substantial portion of the population experiencing chronic pain and more than 650,000 prescriptions dispensed every day, the medical profession must employ every available strategy to address the tragic human and economic costs of opioid misuse, abuse, and dependence. One such tactic is to avoid the need for prescription opioids in the first place, or to limit a patient’s pain management need to a very short duration.
This idea is of great interest to us and prompted a study into the possible role of intraoperative neuromonitoring (IONM) in reducing post-operative readmissions, neurologic complications, and pain in cervical spine patients. Our study, Intraoperative Neurophysiological Monitoring in Cervical Spine Surgeries: Longitudinal Costs and Outcomes, which was originally presented at the Cervical Spine Research Society Annual Meeting in December 2016, found that patients who received IONM during cervical spine surgery had less opiate usage in the year following surgery compared to those who did not receive IONM. The data show that using IONM during cervical spine surgeries:
- Reduced opioid use
- Reduced readmissions
- Reduced neurologic complications
These findings have profound implications for long-term addiction and morbidity, and demonstrate that it is possible to avoid or reduce the need for prescription pain medication after cervical spine surgery, which can create a gateway for opioid addiction.
Prior research using administrative claims data has been limited to a 30-day period after discharge and does not account for differences in patients’ medical histories or ancillary services received. Our study of 8,400 cases took a longer view and controlled for detailed patient characteristics. We found that patients receiving IONM had a significant reduction in nervous system complications one year after surgery and a significant reduction in readmission at 30 days, 90 days, and one year post discharge.
Longitudinal data provide a new and important perspective because complications from surgery may take time to manifest. Additionally, to the extent that patients who receive IONM have a history of higher utilization, controlling for detailed characteristics of patients and their index surgeries is essential to obtaining valid estimates of IONM’s effectiveness. Our follow-up is based on all outpatient and prescription claims as well as hospital claims to detect differences that may not be captured otherwise. We constructed comprehensive measures of patients’ prior medical treatments based on their claims history in the 180 days before surgery, and of ancillary services received during the index hospitalization that may be correlated with, but not caused by, IONM. For these reasons, our approach provides a more accurate assessment of the consequences of IONM.
America’s opioid crisis has reached epidemic proportions. Beyond the adverse health effects and emotional distress for individuals and families, opioid misuse and addiction adds tremendous financial pressure on our healthcare system. With the Centers for Disease Control identifying opioid misuse as one of our top public health challenges, it is clear that changes to medical practice that reduce demand for prescription opiates can have important social, economic, and lifetime health benefits for patients.
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About the Authors
John P. Ney, MD, MPH
Author
