P146. MIS TLIF procedures had lower postoperative opioid consumption compared to single position and traditional percutaneous lumbar spinal fusion approaches

Abstract

<h3>BACKGROUND CONTEXT</h3> One of the reported advantages of MIS spine surgery is less postoperative pain and less postoperative opioid consumption. Traditional lumbar approaches (open TLIF, percutaneous ALIF with flip, and percutaneous LLIF with flip) were compared to minimally invasive (MIS TLIF) and single position (lateral decubitus) anterior posterior surgery (SPS ALIF, SPS LLIF) to evaluate for differences in postoperative opioid consumption. <h3>PURPOSE</h3> To evaluate inpatient MME administration for different lumbar spinal fusion surgeries. <h3>STUDY DESIGN/SETTING</h3> Single-center retrospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 447 single level lumbar spinal fusion procedures from 2013 to 2020: 125 open TLIF, 110 MIS TLIF, 122 Traditional Percutaneous (TP) ALIF/LLIF, and 45 SPS ALIF/LLIF. <h3>OUTCOME MEASURES</h3> Patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. <h3>METHODS</h3> Patients ≥ 18 years of age who underwent one level TLIF or one level ALIF or LLIF with percutaneous posterior instrumentation between L2-S1. All groups included patients with a diagnosis of Grade I spondylolisthesis, stenosis, degenerative disc disease or pars defect. Statistical analysis included independent samples t-tests and chi-square analyses. Propensity score matching (PSM) was used when comparing SPS ALIF/LLIF vs TP ALIF/LLIF to control for age. MME was calculated as per the Centers for Medicare & Medicaid Services. To adjust for differences in length of stay (LOS), inpatient MME was quantified as a rate per hour. Significance set at p<0.05. <h3>RESULTS</h3> There were no differences in demographics except the MIS TLIF group was older (55.9±12.5 vs 51.6±13.1, p=0.011) than TP ALIF/LLIF. After a PSM for age, SPS ALIF/LLIF had shorter op times (202.3±71.0 vs 271.8±77.7 min, p=0.000) and showed no differences in total MME (322.4 ± 397.8 vs 342.5 ± 243.7, p=0.463) or rates of ileus (both 0%) compared to TP ALIF/LLIF. MIS TLIF had a shorter LOS compared to open TLIF (2.6±1.4 vs 3±1.7 days, p=0.000), lower total MME administration (214.1±235.4 vs 310.3±373.4, p=0.021) but no difference in total MME per hour (3.2±2.4 vs 3.7±2.8, p=0.198). MIS TLIF had shorter op time (212.1±66.4 vs 271.8 ±77.7 min, p=0.000), LOS (2.6±1.4 vs 3.5±1.6 days, p=0.000) and total MME (214.1±235.3 vs 342.5±243.7, p=0.000) than TP ALIF/LLIF. MIS TLIF also had shorter LOS (2.6±1.4 vs 3.3±2.1days, p=0.017), lower total MME (214.1±235.4 vs 322.4±397.8, p=0.037) and similar rates of ileus (0.9% vs 0.0%, p=0.521) compared to SPS ALIF/LLIF. <h3>CONCLUSIONS</h3> Patients undergoing MIS TLIF had lower inpatient opioid intake compared to open TLIF, single level TP ALIF/LLIF, and single level SPS. When propensity score matching for age, there was no difference in opioid administration post operatively in patients undergoing TP ALIF/LLIF or SPS ALIF/LLIF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.