Validating the Stopping Opioids after Surgery (SOS) score for sustained postoperative prescription opioid use in spine surgical patients

Spine J. 2019 Oct;19(10):1666-1671. doi: 10.1016/j.spinee.2019.05.001. Epub 2019 May 9.


Background context: The opioid epidemic has increased scrutiny of health-care practices and care episodes, such as surgery, that increase the risk of opioid dependence. The Stopping Opioids after Surgery (SOS) score to predict sustained prescription opioid use was previously developed within a population of patients receiving general surgery, orthopedic, and urologic procedures. Notably, the performance for this score has not been assessed in a spine surgical cohort.

Purpose: We sought to validate the SOS score in a series of patients undergoing cervical and lumbar spine surgery, including inpatient and outpatient cohorts.

Study design/setting: Retrospective review at two academic medical centers and three community hospitals.

Outcome measures: Sustained prescription opioid use was defined as opioid prescription without interruption for 90 days or longer following surgery.

Methods: The performance of the SOS score was assessed in the study population by calculating the c-statistic, receiver-operating curve, and observed rates of sustained prescription opioid use.

Results: Among 7,027 patients included in this study, 2,374 (33.8%) underwent anterior cervical discectomy and fusion and 4,653 (66.2%) underwent surgery for lumbar disc herniation. The median age was 46 (interquartile range=38.0-53.5). Overall, 604 patients (8.6%) had prolonged opioid prescription. The c-statistic of the risk score was 0.764. The sensitivity of the score at the low risk cutoff of 30 was 0.72. At the high-risk cutoff of 60, the specificity was 0.99. The observed risk (95% confidence interval) of prolonged opioid prescription was 3.6% (3.1-4.2) in the low-risk group (scores <30), 17.2% (15.6-18.7) in the intermediate-risk group (scores 30-60), and 46.0% (36.2-55.9) in the high-risk group (scores >60).

Conclusions: We have validated the use of a clinically relevant bedside risk score for sustained prescription opioid use after spine surgery. The score's ease of use, combined with its exceptional performance, renders it a valuable tool for spine care providers in counseling patients and determining appropriate postdischarge management to prevent sustained opioid use.

Keywords: Anterior cervical discectomy and fusion; Lumbar disc herniation; Opioid dependence; Prediction; Risk score; Spine surgery.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Diskectomy / adverse effects*
  • Drug Administration Schedule*
  • Female
  • Humans
  • Intervertebral Disc Degeneration / surgery*
  • Intervertebral Disc Displacement / surgery*
  • Male
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / etiology
  • Opioid-Related Disorders / prevention & control
  • Pain, Postoperative / drug therapy*
  • Risk Factors


  • Analgesics, Opioid

Supplementary concepts

  • Intervertebral disc disease