Postoperative Narcotic Utilization in Medicare Beneficiaries Following an Anterior Lumbar Interbody Fusion

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

Disclosures: Abbas Naqvi BS 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, Islam Elboghdady None, Eric Sundberg MD None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None,

Introduction:
Adequate postoperative pain management can be challenging in older and more comorbid patients who may be sensitive to the side-effects of narcotics. Despite this concern, few studies have assessed the differences in narcotic administration between Medicare (MC) and non-MC patients following lumbar spinal fusion surgery.

Aims/Objectives:
To analyze the daily and cumulative narcotic consumption following an anterior lumbar interbody fusion (ALIF) stratified by payor.

Methods:
88 patients who underwent a primary one- or two-level ALIF procedure for degenerative spinal pathology between 2007-2013 were retrospectively analyzed. Patients were stratified based upon the primary payor status (MC vs non-MC) and assessed with regards to patient demographics, comorbidity burden, smoking status, length of hospitalization, and peri-operative outcomes. The cumulative and daily (postoperative day (POD)) in-hospital oral morphine equivalent (OME) dose was analyzed with regards to the day of discharge. Statistical analysis was performed with a chi-squared test for categorical variables and Student-Test 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 88 ALIF procedures included in this analysis, 13 (14.8%) were performed on MC beneficiaries. MC patients were older (62.9±11.2 vs 45.1±11.3 years old; p<0.05), and demonstrated a greater comorbidity burden (CCI: 3.62±1.76 vs 1.49±1.39; p<0.05). There were no significant differences in operative times or rates of in-hospital complications between the two cohorts. On average, MC patients incurred an additional 12 hours in hospital stay compared to non-MC patients, however this was not significant (p=0.23). Cumulative narcotic consumption did not significantly differ between cohorts regardless of the day of discharge (POD 1: 27.5 vs 49.2±26.9 mg, p=0.33; POD 2: 75.2±27.6 vs 96.9±145.3 mg, p=0.95; POD 3+: 190.9±300.0 vs 119.3±55.6 mg, p=0.27).

Conclusions:
This analysis demonstrates variable narcotic consumption based upon the day of discharge and type of insurance. Although not statistically significant, the MC cohort demonstrated lower narcotic consumption than the non-MC cohort in patients discharged on POD 1 and POD 2. The greater cumulative narcotic dose demonstrated in MC patients discharged on POD 3 or later may be associated to the longer hospitalization incurred by this particular patient population. Further studies are warranted to better characterize the differences in postoperative narcotic requirements between MC and non-MC beneficiaries following ALIF procedures.