Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Disclosure(s):
Aladine A. Elsamadicy, MD: No financial relationships to disclose
Introduction: The aim of this study was to assess the impact of being elderly on inpatient opioid consumption and healthcare resource utilization in patients undergoing spinal fusion for adult spinal deformity (ASD).
Methods: A retrospective study was performed using the Premier Healthcare Database (2016-2017). Adult patients who underwent thoracic/thoracolumbar fusion for ASD 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, postoperative complications, and healthcare resource utilization were assessed. High opioid use was defined as morphine milligram equivalent (MME) consumption >75th percentile for the cohort during the admission. Multivariate analysis was used to identify independent predictors of increased opioid consumption, cost, and non-routine discharge (NRD).
Results: Of the 1,831 patients identified, 199 (10.9%) were in the Young cohort, 599 (32.7%) were in the Older cohort, and 1,033 (56.4%) were in the Geriatric cohort. Comorbidity burden (p < 0.001) and frailty (p < 0.001) increased with age, though complication rates were similar. A greater proportion of Older patients consumed a high amount of opioids (p < 0.001) and accrued higher costs (p=0.018). Geriatric patients experienced greater length of stay (p=0.011), higher rate of NRD (p < 0.001), and higher 30-day readmission rate (p=0.004). On multivariate analysis, Geriatric age was independently associated with NRD (OR: 11.59,p < 0.001) and inversely associated with increased opioid consumption (OR: 0.66,p=0.038). Older age was independently associated with increased opioid consumption (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 : Geriatric patients may consume fewer opioids than younger patients but require increased resource utilization on discharge. Additional studies investigating the impact of aging are necessary to improve patient risk stratification, healthcare delivery, and patient outcomes.
