Oral Posters: Thoraco-lumbar Degenerative

Presented by: A. Narain - View Audio/Video Presentation (Members Only)

Author(s):

A. Narain(1), F. Hijji(1), W. Long(1), K. Yom(1), K. Kudaravalli(1), N. Shoshana(1), K. Singh(1)

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

Abstract

Introduction: American Society of Anesthesiologists Score (ASA) has previously been associated with increased rates of complications and costs after spinal surgery. To the authors' knowledge, no studies have examined the association between ASA Score and inpatient pain and narcotics utilization after spinal fusion procedures. In this context, the purpose of this study is to determine the association between ASA score and inpatient pain and narcotics consumption in patients undergoing cervical or lumbar fusion.

Methods: A prospectively maintained surgical database of patients who underwent either a single-level, primary anterior cervical discectomy and fusion (ACDF) or minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for degenerative pathology between 2005-2016 was reviewed. Patients were grouped based on ASA Score ≤ 2 or > 2. ASA score was tested for association with preoperative demographics using student's t-test and chi-squared analysis for continuous and categorical distributions, respectively. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using linear regression.

Results: After exclusion of patients with incomplete preoperative pain scores, a total of 604 patients were included in this analysis; 211 (34.93%) underwent ACDF and 393 (65.07%) underwent MIS TLIF. Of the patients who underwent ACDF, 184 (87.20%) had an ASA score ≤ 2 and 27 (12.80%) had an ASA score > 2. ACDF patients with an ASA score > 2 were older (58.22 vs 46.31 years, p< 0.001), had lower rates of obesity (40.74% vs 63.04%, p=0.027), and had longer duration of hospital stay (38.50 vs. 28.15 hours, p=0.004). There were no differences in inpatient Visual Analogue Scale (VAS) pain scores or inpatient narcotic consumption between cohorts on any postoperative day (p>0.05 for each). Of the patients who underwent MIS TLIF, 314 (79.90%) had an ASA ≤ 2 and 79 (20.10%) had an ASA score > 2. MIS TLIF patients with an ASA Score > 2 were older (59.75 vs 51.21 years, p< 0.001), had higher rates of obesity (64.56% vs 41.53%, p< 0.001), and had longer duration of hospital stay (69.18 vs. 56.42 hours, p=0.011). There were no significant differences in inpatient VAS pain scores or inpatient narcotic consumption between cohorts on any postoperative day (p>0.05 for each).

Conclusions: The results of this study suggest that higher ASA scores are associated with older age and increased length of stay following spinal fusion procedures. Despite this, there are no differences in inpatient pain or narcotics consumption based on ASA score. As such, ASA score may not be predictive of inpatient pain or narcotics utilization after ACDF or MIS TLIF.

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