Oral Posters: Cervical
Presented by: K. Yom - View Audio/Video Presentation (Members Only)
B. Mayo(1), D. Bohl(1), A. Narain(1), F. Hijji(1), K. Kudaravalli(1), K. Yom(1), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Introduction: Several studies have compared the clinical outcomes between hospital and ambulatory-based surgery centers following anterior cervical discectomy and fusion (ACDF). However, the association between narcotic consumption and pain in the immediate postoperative period has not been well characterized. Therefore, the purpose of this study is to examine the relationship between pain, narcotic consumption, and length of stay amongst patients discharged on postoperative day 0 (POD 0) following a 1- or 2-level ACDF at hospital and ambulatory-based surgery centers.
Methods: A surgical registry of patients who underwent a primary, 1- or 2-level ACDF during 2010-2015 was reviewed. Patients were stratified according to operative location: a hospital-based center (HBC) or an ambulatory surgical center (ASC). Only patients that were discharged home on POD 0 were included. Differences in patient demographics and preoperative characteristics were assessed. The location of the procedure and its effect on postoperative outcomes was analyzed using Poisson regression adjusted for preoperative characteristics.
Results: A total of 81 patients were identified, of which 45 (55.6%) and 36 (44.4%) underwent surgery at a HBC or an ASC, respectively. The HBC patients had a greater percentage of privately insured patients (p< 0.001) and a higher comorbidity burden (p=0.046), whereas ASC patients were more likely to have Worker's Compensation as their primary payer (p< 0.001; Table 1). Patients who underwent ACDF at a HBC had greater narcotic consumption (p=0.001) and experienced longer times until discharge (p< 0.001; Table 2). Using the 30th percentile as a limit for total oral morphine equivalent (OME) consumption, 88.9% of ASC patients consumed less, whereas 55.6% of HBC patients consumed more than the 33 OME cutoff (Figure 1). Patients who underwent ACDF at the HBC reported lower VAS neck pain scores at the 6-week (0=0.043) and VAS arm pain at the 6-month (p=0.007) follow-ups, and experienced a greater change in VAS neck pain (p=0.031) at the 6-week follow-up.
Conclusions: This study demonstrates that patients undergoing same day surgery at a HBC receive significantly more narcotics during their stay following primary 1- or 2-level ACDFs compared those at an ASC. The increased narcotic consumption in the HBC patients may have resulted in the longer hospital stays observed; however, this did not impact reported inpatient pain, complications, or clinical outcomes. Therefore, patients who undergo ACDF in hospitals and are scheduled to be discharged on POD 0 may be able to receive less narcotics and be discharged sooner without compromising pain control or safety.