General Session: Tumor, Trauma, Infection - Hall F

Presented by: K. Cardinal

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), K. Cardinal(1), J. Guntin(1), J. Markowitz(1), K. Singh(1)

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

Abstract

Introduction: Patient pain and narcotics consumption after spinal procedures has been an emerging topic within the orthopedics literature. Determination of risk factors for increased pain and narcotics utilization is necessary to produce effective analgesia protocols for all patients, while also preventing narcotics-associated side effects and dependence. Preoperative mental health, including depression and anxiety, has been identified as a potential predictor of postoperative outcomes in the general orthopedic literature. However, no previous study has determined whether preoperative mental health is associated with postoperative pain and narcotics utilization after minimally invasive spinal procedures. Therefore, the objective of this study is to determine if there is an association between preoperative mental health as assessed by the Patient Health Questionnaire-9 (PHQ-9) and inpatient pain and narcotics utilization after minimally invasive transforaminal lumber interbody fusion (MIS TLIF) procedures.

Methods: Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. Patients were stratified by preoperative PHQ-9 score (≤2, >2). The PHQ-9 is a validated depression-specific mental health survey in which higher scores are associated with a greater degree of depression symptoms. Student's t-test and chi-square analysis were used to determine if an association existed between PHQ-9 score group and preoperative demographic and operative characteristics. Inpatient pain scores during the postoperative stay were expressed via the Visual Analogue Scale (VAS), while inpatient narcotics utilization was expressed in oral morphine equivalents (OMEs). Multivariate linear regression controlling for preoperative demographic and operative characteristics was used to determine if PHQ-9 score group was associated with differences in inpatient pain and narcotics utilization.

Results: 60 patients were included in this analysis. 51.7% had a PHQ-9 score ≤ 2, while 48.3% had a PHQ-9 score > 2. Patients with PHQ-9 score > 2 were more likely to smoke (20.7% vs. 3.2%, p=0.049), were more likely to be obese (41.4% vs. 23.3%, p=0.006), and had higher preoperative VAS pain scores (6.7 vs. 5.2, p=0.026). On postoperative day (POD) 0 and POD 1, there were no significant differences between PHQ-9 score groups in regards to inpatient VAS pain scores or daily and hourly narcotics consumption (p>0.05 for each).

Conclusions: The results of this study suggest that patients with depression symptoms are more likely to smoke, be obese, and have higher preoperative pain. However, the presence of depression symptoms was not associated with increased pain or narcotics utilization in the immediate postoperative period after MIS TLIF. As such, patients should receive similar analgesic protocols irrespective of the presence of depression symptoms.

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