Narcotic Consumption Following Anterior and Lateral Lumbar Interbody Fusion Procedures

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Abstract

Study Design/Setting:

This is a retrospective analysis of a prospectively maintained surgical registry.

Objective:

To characterize postoperative narcotic consumption in patients undergoing either an anterior lumbar interbody fusion (ALIF) or a lateral lumbar interbody fusion (LLIF).

Background Context:

There is substantial interest in evaluating the safety, efficacy, and outcomes following minimally invasive techniques for lumbar fusion procedures. However, few studies have characterized postoperative narcotic consumption in patients undergoing ALIF or LLIF procedures.

Methods:

Consecutive patients who underwent either an ALIF or LLIF during 2007–2014 were identified. Inpatient narcotic consumption was recorded in oral morphine equivalents and dichotomized as greater or less than the 75th percentile total consumption (elevated or normal inpatient consumption). Demographic, comorbidity, and perioperative characteristics were tested for independent association with inpatient narcotic consumption and with continued narcotic usage during the months following surgery.

Results:

A total of 169 patients met inclusion criteria. Of these, 118 (69.8%) underwent ALIF and 51 (30.2%) underwent LLIF procedures. The risk for elevated inpatient narcotic consumption was greater in patients whose body mass index was≥30 kg/m2 [relative risk (RR), 2.8; 95% confidence interval (CI), 1.6–4.8; P<0.001). The risk for continued narcotic usage at the first postoperative visit was elevated in patients with worker’s compensation payment status (RR, 2.0; 95% CI, 1.5–2.7; P<0.001). The risk for continued narcotic usage at the second postoperative visit was elevated in patients with worker’s compensation payment status (RR, 2.6; 95% CI, 1.7–4.1; P<0.001) and in patients with preoperative narcotic utilization (RR, 2.2; 95% CI, 1.4–3.5; P<0.001).

Conclusions:

The present study suggests that while patients with greater body mass index have increased narcotic consumption as inpatients, preoperative narcotic consumption and worker’s compensation payment status are the best predictors of continued narcotics usage during the months following surgery. Worker’s compensation patients and patients who utilize narcotics preoperatively should be the targets of efforts to reduce continued postoperative narcotic usage.

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