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Hospital Pharmacy 52(11)

Figure 3. Proportion of lumbar spine surgery patients who are using opioids alone overtime within each age categories.

Discussion
The objectives of this retrospective study were to gain an
understanding of LSS trend across various age groups and to
explore the use of opioids and other medications for management of acute post-lumbar surgical pain during hospital stay.
We observed a positive upward trend in LSS performed at
our local hospital, particularly in 65 years and older age
group. There was a slight decrease in LSS in middle aged
patients (45-54 years) over the 7 years from 2007 to 2014. In
this population, multiple procedures were more commonly
performed than individual surgeries such as discectomy,
laminectomy, or fusion. However, among individual surgeries, laminectomy was the most frequent procedure performed
in older adults (>65 years) and discectomy was most frequent procedure performed in younger patients. The usage of
opioids alone in postoperative pain management is ubiquitous across all lumbar surgery types and all age categories.
Overall, medication use (opioid or in combination) increased
with age. Reasons for the increase in LSS rate and medication use in older population are unclear but may be due to
increasing prevalence of chronic LBP,21 aging population,6
and seeking health care services22-24 or a combination of any
of these contributing factors.

LSS Trend
We observed an upward trend in the LSS between 2007 and
2014, which echoes findings from other studies that reported
a similar increase in LSS prevalence till 2007.21,25,26 Previous
studies conducted prior to 2007 showed significant increases
in prevalence of LSS. Using state data and patient survey,
Freburger et al. reported a 157% increase in lumbar surgical
procedures per person in North Carolina population between
1997 and 2005.21 Deyo et al. reported a 15-fold increase in

spinal fusion surgeries from 2002 to 2007.22 We report near
50% increase in LSS from 2007 to 2014 in this one-center
study. The prevalence of LSS in the United States is at least
40% higher than in any other country in the world, and 5
times higher than in England and Scotland.25,26
While examining surgery types, we found that multiple
procedures (34.8%) were performed most frequently in this
cross-sectional study population. Laminectomy and discectomy procedures were performed in equal percentage (about
30%), and the fusion procedures (alone) constituted only 10%
of all the LSS performed. The rise in LSS procedures was
about 2 times in patients aged 65 years and older over this time
period. About 31% of patients (628 of 2031) who underwent
LSS were aged 65 years and older. Patients aged 65 years and
older constituted the majority among those who had spinal
laminectomy (51%: 437 of 857). We observed the rate of laminectomy procedure increased with patients' age, whereas the
rate of discectomy procedure decreased with patients' age, but
this should be confirmed in future with large-scale studies.
Findings from this study is in accordance with other studies that have reported a rise in LSS among the older population. The US NCHS reported a 67% increase in LSS till 2007
for patients aged 65 years and older.17 No additional studies
have examined the prevalence of LSS specifically in patients
aged 65 and older. Majority of these patients and patients
between ages of 55 and 64 underwent laminectomy.
Meanwhile, patients in younger age categories had greater
prevalence of discectomy procedures.

Medication Usage
Following any surgery, approximately 75% of patients experience moderate to severe postoperative pain,11,27-29 emphasizing that effective pain management is an important aspect

Table of Contents for the Digital Edition of Hospital Pharmacy - December 2017