Primary Versus Revision Lumbar Diskectomy: Peri-Operative Narcotic Utilization

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,

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,

Introduction:
Revision surgeries are often associated with longer operative times, greater blood loss, and increased complications as a result of altered anatomy and scar tissue. However, few studies have assessed these risks and the associated postoperative narcotic requirements in the setting of a minimally invasive lumbar diskectomy (LD).

Aims/Objectives:
To evaluate the differences in postoperative narcotic consumption between primary and revision lumbar diskectomies (LD) performed through a minimally invasive (MIS) approach. Methods: 238 patients who underwent a primary (n=202) or revision (n=36) single-level minimally invasive lumbar diskectomy were retrospectively analyzed utilizing a prospectively collected patient database. Patient demographics, comorbidity burden, smoking status, intraoperative parameters, rates of in-hospital complications, and length of hospitalization were assessed. Cumulative and daily (postoperative day (POD)) in-hospital narcotic consumption expressed in oral morphine equivalent (OME) doses) were assessed 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:
Except for a higher proportion of active smokers (35.3% vs 18.5%, p<0.05) in revision cases, there were no significant differences in patient demographics or comorbidity burden between cohorts. The surgical times and estimated blood loss were comparable between the two cohorts. However, patients who underwent a revision LD incurred a longer hospitalization (14.4±12.8 vs 11.0±8.2, p<0.05) than primary cases. The daily and cumulative narcotic consumption did not significantly differ between primary and revision MIS LD procedures. (POD 0: 18.8±11.7 vs 22.5±10.8, p=0.13; POD 1: 46.8±24.9 vs 48.7±11.1 mg, p=0.88; POD 2: 44.5=6±27.9 vs 53.5±36.9 mg, p=0.98)

Conclusions:
This analysis demonstrates that revision LD performed with a minimally invasive technique are not associated with longer operative times, blood loss, or greater narcotic requirement compared to a primary MIS LD. Although further prospective large-scale studies are warranted, these findings suggest that patients who undergo a revision LD through a minimally invasive approach are unlikely to require greater narcotic consumption than primary cases for adequate postoperative pain control.