Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: Opioids are commonly used postoperative medications. However, few studies have assessed the effects of increased inpatient opioid consumption on outcomes following metastatic spinal column tumor surgery. The aim of this study was to assess the impact of increased inpatient opioid consumption on outcomes following metastatic spinal column tumor surgery.
Methods: A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). All adult patients who underwent metastatic spinal tumor surgery, identified using ICD-10-CM coding, were grouped by inpatient MME (morphine milligram equivalents) consumption: Low ( < 25th percentile for the cohort), Medium (25th-75th percentile), and High (>75th percentile). Demographics, comorbidities, adverse events (AEs), length of stay (LOS), non-routine discharges, cost, and 30-day readmissions were assessed. Multivariate analyses were performed to determine the association between MME consumption and extended LOS and increased 30-day readmission rates.
Results: Of the 1,104 study patients, 276 (25.0%) had Low MME consumption, 552 (50.0%) had Medium consumption, and 276 (25.0%) had High consumption. MME consumption decreased as age increased (65+ years old: Low:68.8% vs Medium:51.6% vs High:37.7%,p < 0.001). A greater proportion of patients in the High cohort had a prior opioid-related disorder (Low:0.7% vs Medium:1.8% vs High:3.6%,p=0.047). The proportion of patients with ≥1 perioperative AE increased with MME consumption (Low:36.9% vs Medium:53.1% vs High:66.7%,p < 0.001). The proportion of patients with an extended LOS increased with MME consumption (Low:8.3% vs Medium:17.9% vs High:45.7%,p < 0.001). Increased cost (Low:14.5% vs Medium:21.2% vs High:43.1%,p < 0.001) and non-routine discharge rates (Low:58.1% vs Medium:64.5% vs High:73.4%,p=0.010) each increased with MME consumption, while 30-day readmissions did not (p=0.620). On multivariate analysis, Medium and High MME consumption significantly predicted extended LOS [Medium:OR:2.31, p=0.001; High:OR:8.5, p< 0.001], but did not predict increased 30-day readmissions.
Conclusion : Our study shows that increased inpatient opioid consumption significantly predicts extended LOS in patients undergoing metastatic spinal column tumor surgery.
