(SS#III) A Medicare Database Cost Analysis of Common Perioperative Drugs in Neurosurgery: 2016-2020

Introduction: Neurosurgical procedures require careful administration of perioperative medications to improve patient outcomes. Despite medicinal advances to mitigate the overuse of common perioperative drugs, such as opioids for pain management, prescription costs continue to rise. Thus, the goal of this study is to analyze trends in the use and cost of neurosurgical perioperative medications in order to optimize resource allocation and health sector planning.

Methods: Data were queried from the Medicare Part D database for nine common perioperative medications prescribed by neurosurgeons from 2016-2020. Variables included the amount, cost, and length of prescriptions. Data were analyzed in R using univariate t-test comparisons with statistical significance indicated by p< 0.05.

Results: The total number of prescriptions written by neurosurgeons for the nine queried perioperative drugs decreased by 16.34% from 2016-2020. During this period, there were notable decreases in the number of prescriptions by drug, including Lidocaine (-74.88%), Fentanyl (-69.45%), Diazepam (-57.47%), and Hydromorphone (-48.05%). Pregabalin was the only drug that demonstrated an increase in prescriptions (20.06%) during the study period. A comparison of average cost from 2016-2020 revealed a significant increase in cost for Pregabalin, Lidocaine, and Dexamethasone (p < 0.001).

Conclusion : The results indicated that while the use of many opioid drugs, such as fentanyl and hydromorphone, have decreased from 2016-2020, non-opioid analgesics, such as pregabalin, have dramatically increased. This trend suggests a possible shift towards the off-label use of these drugs, helping to improve patient outcomes and decreased opioid dependence. Finally, it is imperative to combat the rising drug costs for perioperative drugs, regardless of prescription trends and usage, which may improve post-operative patient quality of life.