Narcotic Consumption Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion: An Age Based Analysis

Presented at SMISS Annual Forum 2014
By Islam Elboghdady
With Kern Singh MD, Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Anton Jorgensen MD, Khaled Aboushaala MD, Blaine Manning BS,

Disclosures: Islam Elboghdady None Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th, Sreeharsha Nandyala BA None, Alejandro Marquez-Lara MD None, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Blaine Manning BS None,

Elderly patients may be at a greater risk of narcotic related adverse events in the immediate postoperative period. As such, these patients are likely to benefit from techniques to minimize postoperative narcotic consumption.

To characterize the differences in postoperative narcotic consumption based upon patient age following a minimally invasive (MIS) Transforaminal Lumbar Interbody Fusion (TLIF) procedure.

136 patients who underwent a primary single- level MIS TLIF procedure for degenerative spinal pathology between 2006-2013 were retrospectively analyzed. Patients were stratified by age at the time of surgery into four cohorts (>35, 35-50, 51-64, and > 65 years) and assessed with regards to patient demographics, comorbidity burden, smoking status, duration of hospitalization, peri-operative outcomes, and daily (postoperative day (POD)) in-hospital oral morphine equivalent (OME) dosage. Statistical analysis was performed with a chi-squared test for categorical variables and one-way ANOVA for continuous variables. OME means were compared utilizing non-parametric analysis to adjust for skewedness. A p-value of <0.05 denoted statistical significance.

Of the 136 MIS TLIF procedures, 68 (50%) were performed on patients between the ages of 51 and 64 years old. Older patients demonstrated a greater comorbidity burden (p<0.05). Intraoperative parameters, rate of peri-operative complications, and length of hospitalization did not significantly differ between age groups. Cumulative narcotic consumption was greatest in patients <35 years old discharged on POD 2 (65: 63.1±25.9; p=0.14) and POD 3 (65: 70.4±46.9; p=0.06). In contrast patients <35 years old demonstrated the lowest cumulative OME dose among patients discharged on POD 1 (65: 35.5±11.9; p=0.11).

This analysis demonstrated distinct peri-operative narcotic consumption patterns between age groups following an MIS TLIF. Patients <35 years old and between 51-64 demonstrated a significant increase in cumulative daily OME dose with increasing POD. In general patients >65 years old received lower narcotic dosing compared to the other age groups. These age-based differences in postoperative narcotic consumption in the setting of MIS TLIF procedures warrant further investigation.