151. Comparison of opioid consumption patterns of three interbody fusion surgical techniques

BACKGROUND CONTEXT Back pain and spine surgery have been major drivers of opioid consumption and spine surgery has been linked to the opioid epidemic. With increased awareness of the opioid crisis, the focus postoperatively has shifted to managing surgical site pain while minimizing narcotic use. Numerous studies have compared clinical outcomes and fusion status of different lumbar interbody fusion techniques; however, there is limited literature evaluating narcotic consumption postoperatively between techniques. The aim of this study was to assess and compare in-house and postoperative opioid consumption among three surgical techniques. PURPOSE To examine posterior lumbar fusion surgical techniques and compare opioid consumption across the techniques. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Three hundred and three patients who underwent one- or two-level posterior lumbar interbody fusion surgery. OUTCOME MEASURES Primary outcome measure was opioid consumption across surgical techniques both while in-patient and after discharge as determined by total morphine equivalent dose (MED). Secondary outcomes included operative time, length of stay, and discharge destination. Methods This is a retrospective review of patients who underwent one- or two-level posterior lumbar interbody fusion surgery at a single institution between 2016 and 2020. Patients were stratified by surgical technique: posterior lumbar interbody fusion (PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and cortical screw (CS) instrumentation with interbody fusion. Age, ASA, BMI, depression, preoperative opioid use, EBL and OR time were recorded and compared across surgical groups using one-way ANOVA and chi-square analysis. Total morphine equivalent dose (MED) was tabulated for both in-house consumption and postoperative prescriptions and was compared across surgical techniques using ANOVA analysis. Results A total of 303 patients underwent one- or two-level posterior lumbar interbody fusion between 2016 and 2020. 123 patients underwent cortical screw instrumentation, 96 underwent PLIF and 84 underwent MIS-TLIF. There was a significantly higher percentage of patients who had a history of depression and were on preoperative opioids in the CS group (p=0.001, p=0.002). Patients with CS instrumentation required significantly less narcotics per day while in-house compared to PLIF and MIS-TLIF (MED 80.65 vs 97.85 vs 83.72, p = 0.030). Patients who underwent CS instrumentation received half the number of narcotics compared to PLIF patients after discharge (MED 956.15 vs 2260.89, p = 0.003). Conclusions Patients who underwent CS instrumentation required less narcotics postoperatively both while admitted and after discharge. CS instrumentation may be associated with less postoperative pain due to the less invasive approach, however, patient education and prescriber practice also play a role in postoperative narcotic consumption. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.