P56. Preoperative patient activation is not associated with inpatient pain or narcotic utilization after minimally invasive lumbar discectomy

Abstract

BACKGROUND CONTEXT Minimally invasive lumbar microdiscectomy (MIS LD) is a commonly utilized treatment for symptomatic lumbar disc herniations. Recent investigations have focused on the role of patient engagement and involvement in their postoperative outcomes, referred to as patient activation. Increased patient activation has been associated with superior pain relief and functional recovery after spine procedures. However, no previous study has investigated the association of patient activation with immediate postoperative pain and narcotic consumption following MIS spinal procedures. PURPOSE To determine if an association exists between preoperative Patient Activation Measure (PAM) score and inpatient postoperative pain scores and narcotic utilization after MIS LD. STUDY DESIGN/SETTING Retrospective analysis. PATIENT SAMPLE Forty-seven patients with complete PAM scores and postoperative pain records who underwent primary, single-level MIS LD from 2015-2017. OUTCOME MEASURES Inpatient Visual Analogue Scale (VAS) pain score and inpatient narcotic consumption, quantified as oral morphine equivalents (OMEs). METHODS A prospectively maintained surgical database of patients who underwent primary, single-level MIS LD from 2015-2017 for degenerative pathology was retrospectively reviewed. Patients were grouped by top and bottom halves of preoperative PAM score (≤62, >62). VAS pain scores were used to characterize postoperative pain perception in patients. Inpatient narcotic consumption through discharge were quantified as OMEs. PAM score group was tested for an association with preoperative demographic and perioperative characteristics using student s t-test and chi-square analysis for continuous and categorical variables, respectively. Multivariate linear regression was used to test for an association between PAM score group and inpatient pain scores, and narcotic consumption on postoperative day (POD) 0. RESULTS Of the 47 patients were included in this analysis, 46.8% (22) had a PAM score of ≤62, while 53.2% (25) had a PAM score of >62. There were no significant differences in age, gender, body mass index, smoking status, preoperative comorbidity burden, or preoperative VAS pain score between cohorts (p>0.05 for each). Additionally, there were no significant differences between PAM score groups in regards to perioperative variables including operative time, estimated blood loss, and length of inpatient stay (p>0.05 for each). Finally, there were no significant differences in VAS pain scores or total and hourly narcotic consumption between PAM score groups and on POD 0 after MIS LD (p>0.05 for each). CONCLUSIONS Patient engagement and involvement, as measured by PAM score, was not associated with demographic or perioperative differences among those undergoing MIS LD. Additionally, patient activation was not a predictive factor for perceived pain and narcotics use in the immediate postoperative period after MIS LD. The reduced surgical trauma of MIS LD compared to other spine procedures limits the degree of postoperative pain that patients experience, thus reducing overall narcotic requirement. This may minimize the effect of patient motivation and therefore patient activation on postoperative narcotic use in this cohort. More investigation is required, specifically analyzing the role of patient activation in long-term, post-discharge narcotics usage and dependence after MIS procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.