Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: Opioids are common medications used following spine surgery. However, few studies have assessed the impact of increased inpatient opioid consumption on outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to determine the impact of increased inpatient opioid consumption on hospital length of stay (LOS) following PSF for AIS.
Methods: A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). Adolescent patients (11-17 years old) who underwent PSF for AIS, identified using ICD-10-CM coding, were stratified by inpatient MME (morphine milligram equivalent) consumption into Low ( < 25th percentile for the cohort), Medium (25th-75th percentile), and High (>75th percentile) cohorts. Demographics, comorbidities, intraoperative procedures, adverse events (AEs), length of stay (LOS), non-routine discharges, costs, and 30-day readmissions were assessed. A multivariate analysis was performed to determine the association between inpatient MME consumption and extended LOS.
Results: Of the 1,042 study patients, 260 (24.9%) had Low, 523 (50.2%) had Medium, and 259 (24.9%) had High MME consumption. The number of postoperative AEs experienced was similar across the cohorts (p=0.629). A greater proportion of patients in the High cohort had an extended LOS (Low: 6.5% vs Medium: 8.6% vs High: 19.7%, p< 0.001), while a greater proportion of patients in the Low cohort had increased costs (Low: 33.1% vs Medium: 20.3% vs High: 26.6%, p< 0.001). The High cohort had increased 30-day readmission rates relative to the Low and Medium cohorts (Low: 0.8% vs Medium: 0.2% vs High: 1.5%, p=0.049). Non-routine discharge rates were similar among the cohorts (p=0.441). On multivariate analysis, high, but not medium MME consumption was significantly associated with extended LOS [Medium: aOR: 1.48, p=0.193; High: aOR: 4.43, p< 0.001].
Conclusion : Our study showed that high postoperative MME consumption was significantly associated with extended LOS in patients undergoing PSF for AIS.
