P28. Postoperative complications of opioid alternatives in common lumbar spine procedures

Abstract

BACKGROUND CONTEXT Lumbar fusions are commonly used surgical techniques for the treatment of instability and degenerative disc disease. Few studies have examined if the non-opioid analgesics Gabapentin and Pregabalin can effectively manage postoperative pain following common lumbar fusion procedures. PURPOSE This study aims to examine postoperative complications associated with the use of non-opioid analgesics (ie, Gabapentin or Pregabalin) for postoperative pain management following anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING Retrospective database review. PATIENT SAMPLE Patient cohort identified using MSpine national database that includes patients of all payer types who received fusion procedures. OUTCOME MEASURES Complications examined included the following: neurologic, GI, respiratory, DVT and pulmonary embolism, pruritus, mental disorders, urinary incontinence and postoperative pain. METHODS The MSpine national database was queried with relevant Current Procedural Terminology (CPT) codes for patients who underwent an ALIF, PLIF, or TLIF between 2010 to 2019. Patients were organized into anterior approach and posterior approach groups and further queried using National Drug Codes (NDC) to form cohorts of patients who received (i) exclusively opioids, or (ii) a mix regimen, for postoperative pain management. A search of relevant International Classification of Diseases (ICD-9 and ICD-10) codes identified the postoperative surgical and medical complications. Propensity score matching for age, gender, and Charlson Comorbidity Index was performed to control for potential confounding factors. Odds ratios and CI will be used to compare postoperative complication rates between the various groups. RESULTS The anterior_opioids group included 22,581 patients (45.5% male and 54.5% female) and the anterior_mix group included 2,192 patients (37.2% male and 62.8% female). The posterior_opioids group included 22,279 patients (48.0% male and 52.0% female) and the posterior_mix group included 2,677 patients (39.4% male and 60.6% female). After propensity score matching, the anterior groups and posterior groups were 2,182 and 2,671 patients, respectively. The incidence of postoperative pain at 6 weeks was higher in anteriormix (6.0%) than anterior_opioids (3.9%); similarly, this incidence was higher in posterior_mix (8.6%) than posterior_opioids (5.6%). The incidence of mental disorders at 3 weeks was higher in anterior_opioids (6.9%) than anterior_mix (5.8%), while the incidence of GI complications at 3 weeks was lower in anterior_opioids (3.1%) than anterior_mix (3.8%). Respiratory complications at 3 weeks were higher in posterior_mix (2.5%) than posterior_opioids (1.9%). Furthermore, neurologic complications at 3 weeks were higher in posterior_mix (2.3%) than posterior_opioids (1.9%). CONCLUSIONS Patients receiving opioids and Gabapentin or Pregabalin for postoperative pain management following ALIF had higher incidence of postoperative pain and GI complications, but lower incidence of mental disorders, compared to patients who received opioids. Patients who received a mixed regimen for postoperative pain management following PLIF or TLIF were associated with a higher incidence of postoperative pain, respiratory, and neurologic complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.