The Relationship of Postoperative Pain and Opioid Consumption to Postoperative Delirium After Spine Surgery

Abstract

Purpose

To examine the relationship between postoperative pain and opioid use and the development of postoperative delirium (POD), with attention to the preoperative opioid use status of patients.

Methods

This was a secondary analysis of data from a prospective observational study of patients (N = 219; ≥70 years old) scheduled to undergo elective spine surgery. Maximal daily pain scores (0–10) and postoperative morphine milligram equivalents per hour (MME/hr) were determined for postoperative days 1–3 (D1-3). POD was assessed by daily in-person interviews using the Confusion Assessment Method and chart review.

Results

Patients who reported regular preoperative opioid use (n = 58, 27%) reported significantly greater maximal daily pain scores, despite also requiring greater daily opioids (MME/hr) in the first 3 days after surgery. These patients were also more likely to develop POD. Interestingly, while postoperative pain scores were significantly higher in patients who developed POD, postoperative opioid consumption was not significantly higher in this group.

Conclusion

POD was associated with greater postoperative pain, but not with postoperative opioid consumption. While postoperative opioid consumption is often blamed for delirium, these findings suggest that uncontrolled pain may actually be a more important factor, particularly among patients who are opioid tolerant. These findings underscore the importance of employing multimodal perioperative analgesic management, especially among older patients who have a predilection to developing POD and baseline tolerance to opioids.

Keywords:

• postoperative delirium
• pain
• opioids
• spine surgery
• postoperative pain

Data Sharing Statement

The data used to support the findings of this study are available from the corresponding author upon request.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Partners Human Research Committee (PHRC)/Institutional Review Board (IRB).

Consent to Participate

All participants provided informed consent before participating in the study.

Disclosure

There were no relevant conflicts of interest for any of the authors.

Additional information

Funding

The conduct of this study was supported by a grant from the NIH/NIGMS: R35 GM128691 (K.L.S).