Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population.
Neurosurg Focus
; 46(4): E12, 2019 04 01.
Article
em En
| MEDLINE
| ID: mdl-30933913
ABSTRACT
OBJECTIVEThe authors set out to conduct the first national-level study assessing the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population.METHODSData for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013-2014 National (Nationwide) Inpatient Sample database. Multivariable logistic regression was implemented to analyze how OUD status impacted in-hospital complications, length of hospital stay, discharge disposition, and total charges by procedure type.RESULTSA total of 139,995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%, p < 0.0001). OUD patients had higher odds of pulmonary (p = 0.0006), infectious (p < 0.0001), and hematological (p = 0.0009) complications. Multivariate regression modeling of outcomes by procedure type showed that after ALIF, OUD patients had higher odds of nonhome discharge (p = 0.0007), extended hospitalization (p = 0.0002), and greater total charges (p = 0.0054). This analysis also revealed that OUD patients faced higher odds of complication (p = 0.0149 and p = 0.0471), extended hospitalization (p = 0.0439 and p = 0.0001), and higher total charges (p < 0.0001 and p < 0.0001) after PLIF and LLIF procedures, respectively.CONCLUSIONSObtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step toward developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize the outcome profiles for lumbar fusion procedures in OUD patients on a national level, found that this population tended to experience increased odds of complications, extended hospitalization, nonhome discharge, and higher total costs. Results from this study warrant future prospective studies to better the understanding of these associations and to further the development of better ERAS programs that may improve patient care and reduce cost burden.
Palavras-chave
ALIF = anterior lumbar interbody fusion; APR-DRG = All Patient Refined Diagnosis-Related Groups; ERAS = enhanced recovery after surgery; HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, Ninth Edition, Clinical Modification; LDD = lumbar disc degeneration; LLIF = lateral transverse lumbar interbody fusion; NIS = National (Nationwide) Inpatient Sample; National Inpatient Sample; OUD = opioid use disorder; PLIF = posterior lumbar interbody fusion; enhanced recovery; lumbar disc degeneration; opioid use disorders; spine surgery
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Fusão Vertebral
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Degeneração do Disco Intervertebral
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Recuperação Pós-Cirúrgica Melhorada
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Transtornos Relacionados ao Uso de Opioides
Tipo de estudo:
Etiology_studies
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Guideline
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Health_economic_evaluation
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Observational_studies
/
Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Neurosurg Focus
Assunto da revista:
NEUROCIRURGIA
Ano de publicação:
2019
Tipo de documento:
Article