General Session: Value and Outcomes in Spine Surgery - Hall F
Presented by: J. Guntin
B. Haws(1), B. Khechen(1), J. Guntin(1), K. Cardinal(1), A. Wiggins(1), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Introduction: Excess postoperative pain can prolong hospital stay or lead to narcotics dependence. Previous studies have identified preoperative comorbidities and narcotic use as risk factors for increased length of hospital stay, inpatient pain, and narcotics consumption. However, little is known regarding the effects of preoperative medications on outcomes following spine surgery. As such, the purpose of this study is to determine the association between preoperative medications and length of stay, inpatient pain, and narcotics consumption following a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Methods: A prospectively maintained surgical database of patients undergoing primary, single-level MIS TLIF for degenerative pathology between 2015 and 2017 was retrospectively reviewed. Preoperative medications taken within 30 days prior to surgery were recorded for each patient and categorized by medication type. Patient demographic and procedural characteristics were recorded. Patients were categorized based on discharge date, average inpatient Visual Analog Scale (VAS) pain on postoperative day (POD) 0, and narcotics consumption on POD 0 as expressed in oral morphine equivalents (OME). Poisson regression with robust error variance was used to determine the association between preoperative medications and length of stay, pain scores, and narcotics consumption. Multivariate analysis was performed using a backwards, stepwise regression to identify independent risk factors for prolonged stay, increased pain, and greater narcotics consumption.
Results: A total of 138 patients were included in this analysis. On bivariate analysis, benzodiazepines were associated with longer hospital stays (Relative Risk [RR]= 2.1, (95% Confidence Interval [95% CI]=1.09-4.17, p=0.026). Benzodiazepines (RR=5.9, 95% CI=2.69-12.81, p< 0.001) and preoperative narcotics (RR=3.0, 95% CI=1.12-7.80, p=0.029) were risk factors for pain ≥ 7 on POD 0. On multivariate analysis, benzodiazepines were an independent risk factor for prolonged stay. Benzodiazepines, narcotics, and non-steroidal anti-inflammatories were identified as independent risk factors for increased postoperative pain. No risk factors were identified for increased postoperative narcotics consumption.
Conclusions: The results of this study suggest that benzodiazepines are a risk factor for increased length of stay and postoperative pain following MIS TLIF. Preoperative narcotics were also identified as a risk factor for postoperative pain though this did not lead to increases in narcotics consumption. Patients taking these medications should undergo more vigilant perioperative monitoring for adequate pain management. More work must be done to further elucidate the association between preoperative medications and postoperative outcomes following MIS TLIF.