Ahmad Amer H, Carreon Leah Y, Glassman Steven D, Harpe-Bates Jennifer, Sampedro Benjamin C, Brown Morgan E, Daniels Christy L, Schmidt Grant O, Hines Bren, Gum Jeffrey L
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY.
Norton Leatherman Spine Center, Louisville, KY.
Spine (Phila Pa 1976). 2024 Jan 1;49(1):58-63. doi: 10.1097/BRS.0000000000004806. Epub 2023 Aug 23.
Propensity-matched cohort.
The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption.
The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure.
Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared.
Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P =0.014), surgical time (201 vs. 233 min, P <0.001) emergence to extubation time (9.1 vs. 14.2 min, P< 0.001), and recovery room time (119 vs. 140 min, P =0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P =0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P =0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P =0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P =0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients.
OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities.
倾向匹配队列研究。
本研究旨在确定阿片类药物节省麻醉（OSA）是否能减少住院期间及术后1年的阿片类药物消耗量。
近期的阿片类药物危机凸显了减少阿片类药物暴露的必要性。我们制定了一项用于腰椎融合手术的OSA方案，以减轻阿片类药物暴露。
确定因退行性疾病接受一至四个节段腰椎融合手术的患者。排除术前服用阿片类药物的患者。根据年龄、性别、吸烟状况、体重指数、美国麻醉医师协会分级以及翻修手术与初次手术情况，将OSA患者与非OSA患者进行倾向匹配。比较标准人口统计学和手术数据、住院期间每日阿片类药物消耗量以及术后1年的阿片类药物处方量。
在符合纳入标准的296例OSA患者中，172例与非OSA患者进行了倾向匹配。两组患者的人口统计学特征相似（OSA组：77例男性，平均年龄 = 57.69岁；非OSA组：67例男性，平均年龄 = 58.94岁）。与非OSA患者相比，OSA患者的失血量更少（326 mL对399 mL，P = 0.014）、手术时间更短（201对233分钟，P < 0.001）、拔管前苏醒时间更短（9.1对14.2分钟，P < 0.001）以及恢复室停留时间更短（119对140分钟，P = 0.012）。与非OSA组相比，OSA组需要非家庭出院的患者更少（18例对41例，P = 0.001），但住院时间无差异（90.3小时对98.5小时，P = 0.204）。从术后第2天起，OSA组的每日阿片类药物消耗量低于非OSA组（223对185吗啡毫克当量，P = 0.017），并且在术后第4天全天总消耗量更低（293对225吗啡毫克当量，P = 0.003）。术后1、3、6和12个月时，OSA组有有效阿片类药物处方的患者数量在统计学上少于非OSA组患者。
腰椎融合手术采用OSA可减少住院期间及术后1年的阿片类药物消耗量。阿片类药物的最小化使用还可能导致拔管前苏醒时间缩短、恢复室停留时间缩短以及转至非家庭机构的出院人数减少。
