Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 271. Inpatient pain and narcotics utilization based on preoperative PHQ-9 scores after minimally invasive transforaminal lumbar interbody fusion

Abstract

BACKGROUND CONTEXT Patient pain and narcotics consumption after spinal procedures has been an emerging topic within the orthopedics literature. Determination of risk factors for increased pain and narcotics utilization is necessary to produce effective analgesia protocols for all patients, while also preventing narcotics-associated side effects and dependence. Preoperative mental health has been identified as a potential predictor of postoperative outcomes in the general orthopedic literature. However, no previous study has determined whether preoperative mental health is associated with postoperative pain and narcotics utilization after minimally invasive spinal procedures. PURPOSE To determine if there is an association between preoperative mental health as assessed by the Patient Health Questionnaire-9 (PHQ-9) and inpatient pain and narcotics utilization after minimally invasive transforaminal lumber interbody fusion (MIS TLIF) procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 60 patients who underwent a primary, single-level MIS TLIF between 2015 and 2016. OUTCOME MEASURES Inpatient visual analog scale (VAS) pain scores and postoperative narcotics utilization expressed in oral morphine equivalents (OMEs). METHODS A prospectively maintained surgical database of patients undergoing primary, single-level MIS TLIF for degenerative pathology between 2015 and 2016 was retrospectively reviewed. Patients were stratified by preoperative PHQ-9 score (≤2, >2). The PHQ-9 is a validated depression-specific mental health survey in which higher scores are associated with a greater degree of depression symptoms. Student's t-test and chi-square analysis were used to determine if an association existed between PHQ-9 score group and preoperative demographic and operative characteristics. Multivariate linear regression controlling for preoperative demographic and operative characteristics was used to determine if PHQ-9 score group was associated with differences in inpatient pain and narcotics utilization. RESULTS After exclusion of those without complete PHQ-9 surveys, 60 patients were included in this analysis. A total of 51.7% (31) had a PHQ-9 score ≤ 2, while 48.3% (29) had a PHQ-9 score > 2. Patients with PHQ-9 score > 2 were more likely to smoke (20.7% vs. 3.2%, p=.049), were more likely to be obese (41.4% vs. 23.3%, p=.006), and had higher preoperative VAS pain scores (6.7 vs. 5.2, p=.026). On postoperative day (POD) 0 and POD 1, there were no significant differences between PHQ-9 score groups in regards to inpatient VAS pain scores or daily and hourly narcotics consumption (p>.05 for each). CONCLUSIONS The results of this study suggest that patients with depression symptoms are more likely to smoke, be obese and have higher preoperative pain. However, the presence of depression symptoms was not associated with increased pain or narcotics utilization in the immediate postoperative period after MIS TLIF. As such, patients should receive similar analgesic protocols irrespective of the presence of depression symptoms. Further investigation is necessary to determine the incidence of long-term postoperative narcotics dependence after MIS TLIF within a population with depression symptoms. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.