Oral Posters: Thoraco-lumbar Degenerative

Presented by: F. Hijji - View Audio/Video Presentation (Members Only)


F. Hijji(1), A. Narain(1), B. Mayo(1), D. Massel(1), K. Yom(1), K. Kudaravalli(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States


Introduction: Current literature demonstrates smokers experience unfavorable long-term outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures; however, the effect of smoking on postoperative inpatient pain and narcotic consumption has not been previously reported. Therefore, the purpose of the current study is to identify the differences in inpatient pain scores and narcotic usage between smokers and non-smokers following MIS TLIF.

Methods: A prospectively maintained surgical database of patients who underwent a primary, single-level MIS TLIF for degenerative spinal pathology between 2010-2015 was reviewed. Patients were stratified by smoking status. Differences in demographics and preoperative characteristics were assessed using chi-squared analysis and Student's t-test for categorical and continuous variables, respectively. Multivariate analysis comparing peri- and postoperative outcomes was performed using Poisson regression with robust error variance or linear regression adjusted for patient demographics and preoperative characteristics.

Results: A total of 253 patients were included in this analysis, of which 206 (81.4%) were non-smokers, while 47 (18.6%) were smokers. The non-smoker cohort was significantly older (52.0 versus 46.3 years; p=0.004) when compared to the smoker cohort. Patient reported inpatient pain scores were similar on postoperative day (POD) 0 and POD 1, while smokers reported higher pain on POD 2 (5.5 versus 4.7; p=0.040). Narcotic consumption per hour was higher in the smoker cohort on POD 1. No other differences in perioperative outcomes were observed.

Conclusions: The results of this study suggest that smokers may require a slightly higher narcotic dosing regimen to achieve similar inpatient pain scores following a MIS-TLIF as compared to non-smokers. Evidence suggesting this association is demonstrated by smokers reporting higher pain scores on POD 2 at the point when narcotic consumption was most similar between cohorts. Additionally, inpatient pain scores were most similar on POD 1 when the smokers cohort received significantly more narcotics. Lastly, there was a trend towards higher pain scores and higher narcotic consumption in the smoker cohort on POD 0, though neither reached statistical significance. As such, surgeons should be aware that patients who smoke may require a higher narcotic dose to best control their pain.

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