Poster Presentation Sydney Spinal Symposium 2023

Socioeconomic Status and Race Do Not Influence Inpatient Opioid Use in One-Level Posterior Lumbar Fusions for Degenerative Spondylolisthesis (#46)

Lauren Barber 1 2 , S Hickle 3 , S.D. Nelms 4 , H Fraser 5 , K.A. Easley 6 , D Ananthakrishnan 2
  1. UNSW, Mequon, WISCONSIN, United States
  2. Division of Spine Surgery, Emory Orthopaedics and Spine Hospital, Atlanta, Georgia, United States
  3. Division of Neuropsychology, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
  4. Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
  5. Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States
  6. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States

Introduction:
As the opioid epidemic continues, research has shown that opioid use in patients with spinal conditions may differ based on demographic factors, including race and socioeconomic status (SES). However, the majority of studies have evaluated pre-operative and post-operative opioid use; demographic differences in opioid use during the hospitalization is underexplored.

Methods:
This is a retrospective review of patients who underwent one-level lumbar spinal fusion for degenerative spondylolisthesis at a single tertiary academic center from October 2004 – April 2012. Procedure, patient demographics, length of stay (LOS), and inpatient opioid use (morphine milligram equivalents – MMEs) were recorded, as well as whether or not benzodiazepines, steroids, and gabapentin were used. Patients were classified by their distressed communities index (DCI) and environmental designation according to zip code. The DCI is a composite score of 7 metrics (high school education, housing vacancies, employment level and rate, poverty rate, median income ratio, and business growth) used as a proxy for SES developed by the Economic Innovation Group. DCI scores range from 0 (no distress) to 100 (severe distress) and are divided by quartiles, categorized from Prosperous to Distressed. Kruskal-Wallis tests were used to determine whether inpatient opioid utilization differed based on 1) SES (based on the DCI), and 2) steroid, gabapentin, and benzodiazepine use. Exact Chi-square tests were used to evaluate general associations between race and SES (i.e., DCI and environmental designation). Alpha was set at p < 0.05.

Results:
A total of 116 patients were included, 65% female and 35% male. The average age (SD) was 65 (8) years. 1.5% of patients were Asian, 22% Black, 73% White, and 3.5% unknown. 73% of procedures included a transforaminal lumbar interbody fusion (TLIF). 91 patients had documentation on Patient-Controlled Analgesia (PCA) usage. 91% of patients were prescribed a PCA. 100% of patients received opioids while inpatient. The median total MME during the hospitalization was 155 with PCA use and 131 without PCA. The average LOS was 4  1 day. There were no statistically significant differences in inpatient opioid usage based on DCI (p=0.985) or environmental designation (p=0.765). There were statistically significant differences in inpatient opioid usage in patients with steroid (p=0.001) and benzodiazepine use (p<0.001) – more opioid use with steroid or benzodiazepine use. There were no significant differences in inpatient opioid usage between TLIF and non-TLIF patients (p=0.168) or between White and Black patients (p=0.448). Additionally, race was not independently associated with DCI (p=0.065) or environmental designation (p=0.307).