Chronic opioid use and polypharmacy are commonly seen in chronic pain patients presenting for spine procedures. Substance abuse and misuse have also been reported in this patient population. Negative perioperative effects have been found in patients exposed to chronic opioid, alcohol and recreational substances. Toxicology screening testing (TST) in the perioperative period provides useful information for adequate pre-operative optimization and perioperative planning.
We designed a pilot study to understand this population’s pre-operative habits including accuracy of self-report and TST-detected prescribed and un-prescribed medications and recreational substances. We compared the results of the TST to the self-reported medications using Spearman correlations.
Inconsistencies between TST and self-report were found in 88% of patients. Spearman correlation was 0.509 between polypharmacy and intraoperative propofol use, suggesting that propofol requirement increased as the number of substances used increased.
TST in patients presenting for spine surgery is a useful tool to detect substances taken by patients since self-report is often inaccurate. Discrepancies decrease the opportunity for pre-operative optimization and adequate perioperative preparation.