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 V. 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,

Introduction:
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.

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

Methods:
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.

Results:
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).

Conclusions:
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.