Opioid Sparing Anesthesia Decreases In-hospital and One Year Post-Operative Opioid Consumption compared to Traditional Anesthesia: A Propensity-matched Cohort Study.

Abstract

Propensity-matched cohort. To determine if opioid-sparing anesthesia (OSA) reduces in-hospital and one-year post-operative opioid consumption. The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OS) protocol for lumbar spinal fusion surgery to mitigate opioid exposure. Patients undergoing lumbar fusion for degenerative conditions over 1 to 4 levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, BMI, ASA grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption and opioid prescriptions one year after surgery were compared. Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to Non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69y; Non-OSA: 67 males, mean age=58.94y). OSA patients had lower Blood Loss (326mL vs. 399mL, P =0.014), surgical time (201min vs. 233min, P <0.001) emergence to extubation time (9.1min vs. 14.2min, P =<0.001) and recovery room time (119min vs. 140min, P =0.0.012) compared to Non-OSA patients. Fewer OSA patients required non-home discharge (18 vs. 41, P =0.001) compared to the Non-OSA cohort, but no difference in LOS (90.3hrs vs. 98.5hrs, P =0.204). Daily opioid consumption was lower in the OSA versus the Non-OSA cohort from Post-operative Day 2 (223MME vs. 185MME, P =0.017) and maintained each day with lower total consumption (293MME vs. 225MME, P =0.003) throughout Post-operative Day 4. The number of patients with active opioid prescriptions at 1, 3, 6 and 12 months post-operative was statistically fewer in the OSA compared to the Non-OSA patients. OSA for lumbar spinal fusion surgery decreases in-hospital and one-year post-operative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays and fewer discharges to non-home facilities.