DETROIT, Michigan—Analgesics were involved in 21% of deaths occurring in the years after spinal fusion surgery for low back pain, Sham Maghout Juratli, MD, MPH, and colleagues reported in the April 1 issue of Spine.¹ Dr. Juratli, of Wayne State University School of Medicine, Detroit, also found that risk of analgesic-related death is highest among patients with degenerative disc disease (DDD)—especially men aged 45 to 54, and that all of the analgesic-related deaths occurred in subjects who had either intervertebral cage devices or instrumentation. There were no analgesic-related deaths in bone-only fusion recipients.

"Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause," Dr. Juratli said.

Dr. Juratli and colleagues analyzed mortality data for 2,378 workers' compensation patients who underwent spinal fusion surgery in Washington State between 1994 and 2001, 103 of whom had died by 2004.

Nearly 1% of workers who had spinal fusion died of drug overdose

The rate of death within 3 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 these 22 deaths, 20 were with opioid analgesics, and 2 with nonopioid analgesics.

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.

Dt. Juratli said that although other diseases like cancer or heart disease combined to cause more deaths, analgesic-related deaths were the main cause of potential life-years lost because younger patients were more likely to die of analgesic poisoning, whereas older patients were more likely to die of other causes.

Analgesic-related deaths were nearly 3 times higher in workers whose back pain was primarily caused by DDD than in those with other diagnoses. The risk of death due to pain medications was highest among men aged 45 to 54 who had DDD—more than 7 times higher than for other groups.

More fusions, more opioids, more deaths

Dr. Juratli attributed the rising mortality rate to rapid increase in the use of spinal fusion and to more widespread use of opioids for chronic musculoskeletal pain.

“Among individuals aged between 25 to 54 years, the cohort's mortality rate due to analgesic-related poisonings (1.4 deaths per 1000 worker-years) was 10 times the mortality rate due to all accidental and suicidal poisonings of similarly-aged individuals of the general public (0.14 deaths per 1000),” Dr. Juratli said.

Translating research into practice

The researchers point out that analgesic-related deaths, both accidental (19/22) and suicidal (3/22) caused the greatest proportion of potential life lost (31.4%), more than heart disease (9.2%), cancer (9.1%), and liver disease (5.1%) combined. The predominance of patients with degenerative disk disease suggests that this subgroup should be the main target for interventions to minimize analgesic-related deaths after spinal fusion surgery.

Reference

1. Juratli SM, Franklin GM, Mirza SK, et al. Mortality after lumbar fusion surgery. Spine. 2009;34:740-747.