Haws Brittany E, Khechen Benjamin, Patel Dil V, Bawa Mundeep S, Guntin Jordan A, Cardinal Kaitlyn L, Wiggins Adam B, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Clin Spine Surg. 2019 Feb;32(1):E37-E42. doi: 10.1097/BSD.0000000000000713.
This is a retrospective cohort study.
To determine the association between preoperative medications and length of stay, inpatient pain, and narcotics consumption after a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Previous studies have identified risk factors for increased length of hospital stay, inpatient pain, and narcotics consumption. However, little is known regarding the effects of preoperative medications on outcomes after spine surgery.
A prospectively maintained surgical database of patients undergoing primary, single-level MIS TLIF was retrospectively reviewed. Preoperative medications taken within 30 days before surgery were recorded for each patient and categorized by medication type. Poisson regression with robust error variance was used to determine the association between preoperative medications and length of stay, pain scores, and narcotics consumption. Multivariate analysis was performed using a backwards, stepwise regression to identify independent risk factors.
In total, 138 patients were included in this analysis. On bivariate analysis, benzodiazepines were associated with longer hospital stays [relative risk (RR)=2.03; P=0.031]. Benzodiazepines (RR=3.71; P<0.001) and preoperative narcotics (RR=2.60; P=0.012) were risk factors for pain ≥7 on postoperative day 0. On multivariate analysis, benzodiazepines were an independent risk factor for prolonged stay. Benzodiazepines, narcotics, and nonsteroidal anti-inflammatories were identified as independent risk factors for increased postoperative pain.
These results suggest that benzodiazepines are a risk factor for increased length of stay and postoperative pain after MIS TLIF. Preoperative narcotics and nonsteroidal anti-inflammatories were also identified as risk factors for postoperative pain though this did not lead to increases in narcotics consumption. Patients taking these medications should undergo more vigilant perioperative monitoring for adequate pain management. More work must be done to further elucidate the association between preoperative medications and postoperative outcomes after MIS TLIF.
这是一项回顾性队列研究。
确定术前用药与微创经椎间孔腰椎椎间融合术（MIS TLIF）后住院时间、住院期间疼痛及阿片类药物使用量之间的关联。
既往研究已确定了住院时间延长、住院期间疼痛及阿片类药物使用量增加的风险因素。然而，关于术前用药对脊柱手术后结局的影响知之甚少。
对前瞻性维护的接受初次单节段MIS TLIF手术患者的手术数据库进行回顾性分析。记录每位患者术前30天内服用的药物，并按药物类型分类。采用具有稳健误差方差的泊松回归分析来确定术前用药与住院时间、疼痛评分及阿片类药物使用量之间的关联。使用向后逐步回归进行多变量分析以确定独立风险因素。
本分析共纳入138例患者。在双变量分析中，苯二氮䓬类药物与更长的住院时间相关[相对风险（RR）=2.03；P=0.031]。苯二氮䓬类药物（RR=3.71；P<0.001）和术前阿片类药物（RR=2.60；P=0.012）是术后第0天疼痛≥7分的风险因素。在多变量分析中，苯二氮䓬类药物是住院时间延长的独立风险因素。苯二氮䓬类药物、阿片类药物和非甾体类抗炎药被确定为术后疼痛增加的独立风险因素。
这些结果表明，苯二氮䓬类药物是MIS TLIF术后住院时间延长和术后疼痛增加的风险因素。术前阿片类药物和非甾体类抗炎药也被确定为术后疼痛的风险因素，尽管这并未导致阿片类药物使用量增加。服用这些药物的患者应在围手术期接受更密切的监测以进行充分的疼痛管理。必须开展更多工作以进一步阐明MIS TLIF术后术前用药与术后结局之间的关联。
