PMID- 36436433 OWN - NLM STAT- MEDLINE DCOM- 20230522 LR - 20230601 IS - 1872-6968 (Electronic) IS - 0303-8467 (Linking) VI - 224 DP - 2023 Jan TI - Geriatric relationship with inpatient opioid consumption and hospital outcomes after open posterior spinal fusion for adult spine deformity. PG - 107532 LID - S0303-8467(22)00413-9 [pii] LID - 10.1016/j.clineuro.2022.107532 [doi] AB - OBJECTIVE: As the population ages, increasing attention has been placed on identifying risk factors for poor surgical outcomes in the elderly. The aim of this study was to assess the impact of geriatric status on inpatient narcotic consumption and healthcare resource utilization in patients undergoing spinal fusion for adult spinal deformity. METHODS: A retrospective study was performed using the Premier Healthcare Database (2016-2017). All adult patients who underwent thoracic/thoracolumbar fusion for spine deformity were identified using ICD-10-CM codes. Patients were categorized by age: 18-49 years-old (Young), 50-64 years-old (Older), and 65 + years-old (Geriatric). Patient demographics, comorbidities, hospital characteristics, intraoperative variables, adverse events (AEs), and healthcare resource utilization were assessed. Increased inpatient opioid use was categorized by MME (morphine milligram equivalents) admission consumption greater than the 75th percentile of the cohort. Multivariate logistic regression analysis was used to identify independent predictors of increased opioid usage, increased cost, and non-routine discharge (NRD). RESULTS: Of the 1831 patients identified, 199 (10.9 %) were in the Young cohort, 599 (32.7 %) were in the Older cohort, and 1033 (56.4 %) were in the Geriatric cohort. The Geriatric cohort had a greater proportion of patients who were Non-Hispanic White (p < 0.001) and government-insured (p < 0.001). Comorbidities [CCI (p < 0.001)] and frailty [mFI-5 (p < 0.001)] increased with age. AEs occurred at similar rates between cohorts. A greater proportion of Older patients consumed an increased amount of MMEs during their hospital stay (Young: 24.9 % vs. Older: 33.1 % vs. Geriatric: 20.2 %, p < 0.001). A greater proportion of Geriatric patients experienced high costs (p = 0.018), longer LOS (p = 0.011), and 30-day readmission (p = 0.004) compared to other cohorts. A significantly greater proportion of the Geriatric cohort experienced NRD (Young: 25.3 % vs. Older: 58.8 % vs. Geriatric: 83.0 %, p < 0.001) On multivariate analysis, Geriatric age was independently associated with NRD (OR: 11.59, p < 0.001), and inversely associated with increased MME use (OR: 0.66, p = 0.038). However, Older age was independently associated with increased MME use (OR: 1.58, p = 0.026) and NRD (OR: 4.27, p < 0.001), though not increased cost (OR: 1.49, p = 0.077). CONCLUSION: Our study demonstrates that geriatric patients may require fewer opioids than younger patients but require greater resource utilization on discharge. Additional studies investigating the impact of aging are necessary to improve patient risk stratification, healthcare delivery, and patient outcomes. CI - Copyright (c) 2022 Elsevier B.V. All rights reserved. FAU - Elsamadicy, Aladine A AU - Elsamadicy AA AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. Electronic address: aladine.elsamadicy@yale.edu. FAU - Sandhu, Mani Ratnesh S AU - Sandhu MRS AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. FAU - Reeves, Benjamin C AU - Reeves BC AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. FAU - Sherman, Josiah J Z AU - Sherman JJZ AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. FAU - Craft, Samuel AU - Craft S AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. FAU - Williams, Mica AU - Williams M AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States. FAU - Shin, John H AU - Shin JH AD - Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. FAU - Sciubba, Daniel M AU - Sciubba DM AD - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, United States; Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, United States. LA - eng PT - Journal Article DEP - 20221119 PL - Netherlands TA - Clin Neurol Neurosurg JT - Clinical neurology and neurosurgery JID - 7502039 RN - 0 (Analgesics, Opioid) RN - 78185-58-7 (MME) SB - IM MH - Humans MH - Adult MH - Aged MH - Adolescent MH - Young Adult MH - Middle Aged MH - *Analgesics, Opioid/therapeutic use MH - *Spinal Fusion/adverse effects MH - Retrospective Studies MH - Inpatients MH - Treatment Outcome MH - Length of Stay MH - Hospitals MH - Postoperative Complications/epidemiology OTO - NOTNLM OT - Adult spinal deformity OT - Geriatric OT - Healthcare resource utilization OT - Opioid consumption OT - Posterior spinal fusion COIS- Declaration of Competing Interest None. EDAT- 2022/11/28 06:00 MHDA- 2023/05/22 06:42 CRDT- 2022/11/27 18:19 PHST- 2022/10/01 00:00 [received] PHST- 2022/11/16 00:00 [revised] PHST- 2022/11/17 00:00 [accepted] PHST- 2023/05/22 06:42 [medline] PHST- 2022/11/28 06:00 [pubmed] PHST- 2022/11/27 18:19 [entrez] AID - S0303-8467(22)00413-9 [pii] AID - 10.1016/j.clineuro.2022.107532 [doi] PST - ppublish SO - Clin Neurol Neurosurg. 2023 Jan;224:107532. doi: 10.1016/j.clineuro.2022.107532. Epub 2022 Nov 19.