Lumbar Spine Surgeries and Medication Usage During Hospital Stay: One-Center Perspective

Abstract

Pain after spine surgery is usually managed with opioid and nonopioids. The rate of lumbar spine surgeries (LSS) is rising, but current practices on LSS are not known. A current trend in LSS and medication usage by age group is needed to gain a better understanding of how LSS and its pain management vary by age. The aim of this study was to report current practices of LSS of discectomy, laminectomy, and fusion in patients aged 18 and older and to gain an understanding of medication use for management of LSS. This retrospective study analyzed data of the University of Kansas Medical Center from 2007 to 2014 of patients (>18 years of age) undergoing laminectomy, discectomy, and fusion. A total of 19 463 patients underwent LSS between 2007 and 2014 at Kansas University hospital. For the purpose of this study, 3115 patients' medical records were observed. A 50% increase in LSS between 2007 and 2014 was noted. Specifically, more than 2-fold increase in LSS was observed in patients aged 65 years and older. Among those aged 65 years and older, laminectomy was the most commonly performed surgery (69.6%) while discectomy was the most common surgery performed among those aged 18 to 34 (82.9%) and those aged 35 to 44 (72%). The medication use also increased with a highest usage in opioids alone (55%), followed by opioids combined with other analgesics (42.7%), regardless of lumbar surgery type or age. The information of increase in both LSS and the medication usage over the 7 years can be used to gain a better understanding of quality, expenditure, and outcomes following LSS. This knowledge may help health care providers plan patient care and rehabilitation services for older adults, as the trajectory of lumbar spine surgery is likely to rise with growing prevalence of older adults. The information regarding increased opioid utilization may also help clinicians to refine opioid usage and consider alternative approaches to manage acute postoperative pain, in light of the current concerns related to overutilization of opioids.

Association between Opioid Dose, Acute Post‐operative Pain and Walking Distance Following Lumbar Spine Surgery

“…A previous study has shown that 72% of people who underwent LSS were older than 45 years. 9 The outcomes of LSS, however, are not consistent and significantly vary in both the short-and long-term. 10 We have previously shown that standard pain treatment during the average 3-day hospital stay 11,12 following LSS includes the use of opioid analgesics, and about 97.7% of post LSS patients were treated with opioids alone or with multimodal approaches including opioids.…”

“…10 We have previously shown that standard pain treatment during the average 3-day hospital stay 11,12 following LSS includes the use of opioid analgesics, and about 97.7% of post LSS patients were treated with opioids alone or with multimodal approaches including opioids. 9 A multimodal analgesic approach has been shown to accelerate patients' recovery and early mobility following peripheral/spinal surgeries. [13][14][15][16][17] However, post-operative pain is primarily managed by increasing the opioid dose, specifically if patients may require intravenous analgesia.…”

“…We identified our subject cohort from the Healthcare Enterprise Repository for Ontological Narration (HERON) system 24 using i2b2 25 Medical records for patients aged 45 years or older who had their first LSS were included in this study as recent evidence suggests a majority of patients who undergo LSS falls in this age category. 9 We extracted the medical records of the patient cohort with the data on opioid analgesics, pain assessment and gait training following LSS from HERON system. We used the surgery medical encounter to search all variables of interest occurring during the same encounter (from one hospital admission).…”

“…Patients who used a total daily OME dose ≤40 mg was classified as low dose, 41-90 mg was classified as medium dose, and ≥91 mg was classified as high dose. 27 We captured data of the opioid dose on POD1 only because almost all the patients take opioids as the main analgesic on POD1, 9 which enabled us to examine the association between opioid use and pain and function during the hospital stay. Alternatively, types and combinations of overall analgesics (e.g., opioids, non-opioids and other analgesics) vary tremendously among the patients, which makes it difficult to control and compare across patients and is outside the scope of this manuscript.…”

“…F I G U R E 3 Gait distance on POD2 and POD3 Opioid analgesics are the gold standard of pain treatment for those undergoing LSS. 9,16,17 Opioids are one of the most effective analgesics for moderate to severe post-operative pain. 17 However, a high dose of opioids is associated with side effects such as nausea, vomiting, respiratory depression, immune system depression and hormonal disturbance.…”