Pain meds can be fatal after spinal fusion surgery
Pain meds can be fatal after spinal fusion surgery
Highest risk: Middle-aged men with DDD
Pain medications are involved in more than 20% of deaths occurring in the years after spinal fusion surgery for low back pain, reports a study in the April 1 issue of Spine.
The risk of analgesic-related death is highest among patients with degenerative disc disease (DDD), especially men aged 45 to 54, according to the new research, led by Sham Maghout Juratli, MD, MPH, of Wayne State University School of Medicine, Detroit.
Of 2,378 workers' compensation patients who underwent spinal fusion surgery in Washington State between 1994 and 2001, 103 had died by 2004. The researchers analyzed the cause of death for each patient who died.
The rate of death within three years after spinal fusion surgery was 1.9%. Deaths involving pain medications were the single most common category, accounting for 21% of all deaths. Of 22 analgesic-related deaths, 19 were accidental overdoses, and three were suicides. Overall, nearly 1% of workers who underwent spinal fusion died of analgesic poisoning.
Although other diseases such as cancer or heart disease combined to cause more deaths, analgesic-related deaths were the main cause of potential life-years lost. The reason is that younger patients were more likely to die of analgesic poisoning, whereas older patients were more likely to die of other causes.
Workers whose back pain was primarily caused by DDD were at elevated risk of analgesic-related death. The risk was nearly three times higher than those with other diagnoses. The risk of death due to pain medications was highest among men aged 45 to 54 who had DDD. The risk was more than seven times higher than for other groups.
The risk of death in the first three months after spinal fusion surgery was 0.29%. This risk was highest for patients who were undergoing a second spinal fusion procedure.
The use of spinal fusion, also called lumbar fusion, is growing rapidly, despite a lack of agreement over which patients should undergo the procedure. This growth is of special concern because spinal fusion carries a higher risk of complications than other, less extensive surgical procedures. Although the initial risk of death is low, few studies have looked at the mortality rate beyond the first few months after spinal fusion.
The new results raise concern about the long-term risk of death after spinal fusion, especially deaths related to pain medications. The deaths reflect the high use of opioid (narcotic) analgesics by patients with back pain, despite the lack of strong evidence for their effectiveness.
"Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent spinal fusion than any other cause," according to Juratli and colleagues. They believe that initial efforts to reduce analgesic-related deaths should focus on patients with DDD, especially men.
Pain medications are involved in more than 20% of deaths occurring in the years after spinal fusion surgery for low back pain, reports a study in the April 1 issue of Spine.Subscribe Now for Access
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