PMID- 36350557 OWN - NLM STAT- MEDLINE DCOM- 20230301 LR - 20230329 IS - 2212-1358 (Electronic) IS - 2212-134X (Linking) VI - 11 IP - 2 DP - 2023 Mar TI - Association of inpatient opioid consumption on postoperative outcomes after open posterior spinal fusion for adult spine deformity. PG - 439-453 LID - 10.1007/s43390-022-00609-2 [doi] AB - INTRODUCTION: Opioids are the most commonly used analgesic in the postoperative setting. However, few studies have analyzed the impact of high inpatient opioid use on outcomes following surgery, with no current studies assessing its effect on patients undergoing spinal fusion for an adult spinal deformity (ASD). Thus, the aim of this study was to investigate risk factors for high inpatient opioid use, as well as to determine the impact of high opioid use on outcomes such as adverse events (AEs), hospital length of stay (LOS), cost of hospital admission, discharge disposition, and readmission rates in patients undergoing spinal fusion for ASD. METHODS: A retrospective cohort study was performed using the Premier healthcare database from the years 2016 and 2017. All adult patients > 40 years old who underwent thoracic or thoracolumbar fusion for ASD were identified using the ICD-10-CM diagnostic and procedural coding system. Patients were then categorized into three cohorts based on inpatient opioid use: Low MME (morphine milligram equivalents), Medium MME, and High MME. Patient demographics, comorbidities, treating hospital characteristics, intraoperative variables, postoperative AEs, LOS, discharge disposition, and total cost of hospital admission were assessed in the analysis. Multivariate regression analysis was done to determine independent predictors of high inpatient MME, prolonged LOS, and increased hospital cost. RESULTS: Of 1673 patients included, 417 (24.9%) were classified as Low MME, 840 (50.2%) as Medium MME, and 416 (24.9%) as High MME. Age significantly decreased with increasing MME (Low: 71.0% 65 + years vs Medium: 62.0% 65 + years vs High: 47.4% 65 + years, p < 0.001), while the proportions of patients presenting with three or more comorbidities were similar across the cohorts (Low: 20.1% with 3 + comorbidities vs Medium: 18.0% with 3 + comorbidities vs High: 24.3% with 3 + comorbidities, p = 0.070). With respect to postoperative outcomes, the proportion of patients who experienced any AE (Low: 60.2% vs Medium: 68.8% vs High: 70.9%, p = 0.002), extended LOS (Low: 6.7% vs Medium: 20.7% vs High: 45.4%, p < 0.001), or non-routine discharge (Low: 66.6% vs Medium: 73.5% vs High: 80.1%, p = 0.003) each increased along with total MME. In addition, rates of 30-day readmission were greatest among the High MME cohort (Low: 8.4% vs Medium: 7.9% vs High: 12.5%, p = 0.022). On multivariate analysis, medium and high MME were associated with prolonged LOS [Medium: OR 4.41, CI (2.90, 6.97); High: OR 13.99, CI (8.99, 22.51), p < 0.001] and increased hospital cost [Medium: OR 1.69, CI (1.21, 2.39), p = 0.002; High: OR 1.66, CI (1.12, 2.46), p = 0.011]. Preadmission long-term opioid use [OR 1.71, CI (1.07, 2.7), p = 0.022], a prior opioid-related disorder [OR 11.32, CI (5.92, 23.49), p < 0.001], and chronic pulmonary disease [OR 1.39, CI (1.06, 1.82), p = 0.018] were each associated with a high inpatient MME on multivariate analysis. CONCLUSION: Our study demonstrated that increasing inpatient MME consumption was associated with extended LOS and increased hospital cost in patients undergoing spinal fusion for ASD. Further studies identifying risk factors for increased MME consumption may provide better risk stratification for postoperative opioid use and healthcare resource utilization. CI - (c) 2022. The Author(s), under exclusive licence to Scoliosis Research Society. FAU - Elsamadicy, Aladine A AU - Elsamadicy AA AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. aladine.elsamadicy@yale.edu. FAU - Sandhu, Mani Ratnesh S AU - Sandhu MRS AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Reeves, Benjamin C AU - Reeves BC AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Freedman, Isaac G AU - Freedman IG AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Koo, Andrew B AU - Koo AB AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Jayaraj, Christina AU - Jayaraj C AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Hengartner, Astrid C AU - Hengartner AC AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Havlik, John AU - Havlik J AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Hersh, Andrew M AU - Hersh AM AD - Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA. FAU - Pennington, Zach AU - Pennington Z AD - Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. FAU - Lo, Sheng-Fu Larry AU - Lo SL AD - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA. FAU - Shin, John H AU - Shin JH AD - Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. FAU - Mendel, Ehud AU - Mendel E AD - Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA. FAU - Sciubba, Daniel M AU - Sciubba DM AD - Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD, USA. AD - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA. LA - eng PT - Journal Article DEP - 20221109 PL - England TA - Spine Deform JT - Spine deformity JID - 101603979 RN - 0 (Analgesics, Opioid) RN - 78185-58-7 (MME) SB - IM MH - Humans MH - Adult MH - Aged MH - *Analgesics, Opioid/adverse effects MH - *Spinal Fusion/adverse effects MH - Inpatients MH - Retrospective Studies MH - Treatment Outcome OTO - NOTNLM OT - Length of stay OT - Opioid OT - Opioid use OT - Outcomes OT - Posterior spinal fusion OT - Spine deformity EDAT- 2022/11/10 06:00 MHDA- 2023/03/03 06:00 CRDT- 2022/11/09 11:24 PHST- 2022/04/25 00:00 [received] PHST- 2022/10/29 00:00 [accepted] PHST- 2022/11/10 06:00 [pubmed] PHST- 2023/03/03 06:00 [medline] PHST- 2022/11/09 11:24 [entrez] AID - 10.1007/s43390-022-00609-2 [pii] AID - 10.1007/s43390-022-00609-2 [doi] PST - ppublish SO - Spine Deform. 2023 Mar;11(2):439-453. doi: 10.1007/s43390-022-00609-2. Epub 2022 Nov 9.