Peri-Operative Narcotic Consumption following Minimally Invasive Lumbar Decompression Surgery: An Aged 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, Hamid Hassanzadeh MD, Anton Jorgensen MD, Khaled Aboushaala MD, Junyoung Ahn ,

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, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Junyoung Ahn 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 less invasive 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) lumbar decompression (LD) procedure.

Methods:
309 patients who underwent a primary one- or two-level MIS LD procedure (laminectomy or diskectomy) 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 309 LD procedures, the majority (198 (64.1%)) were performed on patients between the ages of 35 and 64 years old. Older patients demonstrated a greater comorbidity burden, longer operative time, higher rate of in-hospital complication (urinary retention) and longer hospitalization (p65 year old cohort (36.8±24.4) (p<0.05).

Conclusions:
Elderly patients did not demonstrate significant differences in cumulative narcotic consumption compared to the younger cohorts following a MIS LD procedure in the immediate postoperative period. Furthermore, patients >65 years old demonstrated lower cumulative OME dose on POD 2 compared to younger patients discharged on that same day. These findings suggest that the greater rate of urinary retention incurred by older patients may be associated with greater age, additional comorbidity and/or sensitivity to narcotics.