Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: B. Haws

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), K. Cardinal(1), J. Guntin(1), K. Tchalukov(1), K. Singh(1)

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

Abstract

Introduction: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is an effective therapy for the treatment of lumbar degenerative disease. Postoperatively, concerns exist regarding pain and narcotics consumption during the inpatient stay. Specifically, physicians must be aware of the possibility of narcotics-associated side effects and dependence in those with severe pain and increased narcotics utilization. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) has been utilized to quantify patients' physical health prior to surgery. The purpose of this study is to determine if preoperative physical health as measured by PROMIS is associated with patient pain and narcotics consumption in the immediate postoperative period after MIS TLIF procedures.

Methods: Patients who underwent primary, single-level MIS TLIF were identified. Patients were grouped by PROMIS score (≥39.9, < 39.9), with higher scores indicating better physical function. Postoperative pain was quantified using the Visual Analogue Scale (VAS), while narcotics consumption was quantified using Oral Morphine Equivalents (OMEs). PROMIS score was tested for an association with postoperative pain and narcotics consumption using multivariate linear regression.

Results: 93 patients were included in this analysis after exclusion of those without PROMIS scores. 62.4% had PROMIS scores ≥ 39.9, while 37.6% had PROMIS scores < 39.9. Patients with PROMIS scores < 39.9 were more likely to be obese (57.1% vs. 36.2%, p=0.049). There were no other differences in age, gender, smoking status, comorbidity burden, or preoperative VAS pain scores between groups (p>0.05 for each). There were no significant differences in operative time or intraoperative blood loss between groups (p>0.05 for each). There was a trend towards longer length of stay in the PROMIS scores < 39.9 group (41.2 vs. 35.1 hours, p=0.141), although this result did not reach statistical significance. In regards to postoperative pain, there were no significant differences between groups in VAS pain scores on postoperative day 0 or postoperative day 1 (p>0.05 for each). Patients with PROMIS scores < 39.9 had higher total narcotic consumption on POD 1 (62.5 vs. 49.8 OMEs, p=0.047), but not on POD 0 (p=0.392). There were no significant differences between groups in hourly narcotic consumption of POD 0 or POD 1 (p>0.05 for each).

Conclusions: Patient physical function was not a risk factor for increased pain after MIS TLIF. While patients with worse physical function had higher total narcotic intake on POD 1, this was likely associated with increases in length of stay compared to patients with better physical function. All patients should be carefully monitored for narcotics-associated side effects postoperatively.

Table 1

Table 2