Wednesday, September 26, 2018 2:00 PM – 3:00 PM Surgery and Opioids: 73. Narcotic consumption following minimally invasive lumbar decompression: a comparison between hospital and ambulatory-based surgery centers

Abstract

BACKGROUND CONTEXT Studies have compared outcomes between hospital-based (HBC) and ambulatory surgery (ASC) centers following minimally invasive lumbar decompression (MIS LD). However, the association between narcotic consumption and pain in the immediate postoperative period has not been well characterized. PURPOSE To examine pain, narcotic consumption, and length of stay (LOS) among patients discharged on postoperative day (POD) 0 following a 1-level MIS LD between an HBC and ASC. STUDY DESIGN/SETTING Retrospective analysis of a prospectively maintained surgical database. PATIENT SAMPLE A total of 235 patients who underwent a primary, 1-level MIS LD procedure from 2013 to 2017. OUTCOME MEASURES Inpatient pain using visual analog scale (VAS) pain scores, and narcotic consumption as oral morphine equivalents (OMEs). METHODS A surgical registry of patients who underwent a primary, 1-level MIS LD during 2013-2017 was reviewed, and were stratified by operative location. Differences between groups in demographics were assessed using independent sample t tests for continuous variables and chi-squared analysis for categorical variables. The operative location and its effect on perioperative characteristics, inpatient pain scores and narcotics consumption was analyzed using multivariate linear regression adjusted for significant patient characteristics. RESULTS A total of 235 patients were identified, of which 90 and 145 underwent surgery at a HBC or ASC, respectively. The HBC cohort exhibited an increased comorbidity burden, as defined by the Charlson Comorbidity Index (HBC: 1.1, ASC: 0.8; p=.041) and were more likely to have private insurance (HBC: 76.7%, ASC: 37.2%; p=.026). Distributions of age, sex, body mass index, and smoking status was similar between groups (p>.05 for each). The HBC cohort recorded shorter operative time (p CONCLUSIONS The results of the current study suggest that patients at who underwent MIS LD at an ASC receive fewer narcotics than patients treated at a HBC, which may contribute to shortened length of stay. Additionally, there was no difference in patient-reported pain between cohorts despite the differences in narcotic utilization. As such, postoperative narcotics administration can be decreased without compromising pain control and may contribute to faster discharge. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.