RESUMO
STUDY DESIGN: This study was a retrospective propensity-matched study of patients receiving opioid sparing anesthesia (OSA) and those who did not receive an opioid sparing anesthesia regimen. OBJECTIVES: To determine whether patients undergoing spine fusion for deformity fared better with an OSA regimen than those not having an OSA regimen. SUMMARY OF BACKGROUND DATA: There has been a tremendous focus on opioid overuse. Accordingly, OSA regimens are being introduced to reduce narcotic use. However, OSA has not been studied in the adult spine deformity population. METHODS: 43 patients undergoing fusion of at least five levels in the thoracolumbar spine received OSA. They were matched to 43 patients who did receive an OSA regimen. We analyzed a number of metrics including blood loss, anesthesia time, post anesthesia care unit (PACU) pain scores, postoperative pain scores, complications, length of stay, and readmissions. RESULTS: The OSA group had significantly lower pain scores both before transfer to (4.6 vs. 7.6, P=0.000) and after transfer from (4.2 vs. 6.2 P=0.002) the PACU. Opioid use was significantly lower in the OSA group (454 vs. 241 MMEs by POD4, P=0.022). Fewer patients required blood transfusion in the OSA (1 vs. 28, P=0.000) group. Fewer patients in the OSA group had constipation and urinary retention (1 vs. 9, P=0.015). There was no difference in discharge home or to a facility. The lengths of hospital (4.33 vs. 6.19, P=0.009) and ICU (0.12 vs. 0.70 days, P=0.009) stay were significantly shorter in the OSA group. CONCLUSION: OSA regimens have numerous benefits in patients undergoing spinal deformity surgery including less opioid use, fewer postoperative complications, and a reduced length of stay.
RESUMO
STUDY DESIGN: Propensity-matched cohort. OBJECTIVE: The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption. SUMMARY OF BACKGROUND DATA: The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure. MATERIALS AND METHODS: Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared. RESULTS: Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P =0.014), surgical time (201 vs. 233 min, P <0.001) emergence to extubation time (9.1 vs. 14.2 min, P< 0.001), and recovery room time (119 vs. 140 min, P =0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P =0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P =0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P =0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P =0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients. CONCLUSIONS: OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities.