286. Early adoption of enhanced recovery after surgery protocol following adult spinal deformity surgery is not associated with decreased in-hospital opioid use

OBJECTIVEThe objectives of the study were to determine, among patients with adult spinal deformity (ASD), the following: 1) how preoperative opioid use, dose, and duration of use are associated with long-term opioid use and dose; 2) how preoperative opioid use is associated with rates of postoperative use from 6 weeks to 2 years; and 3) how postoperative opioid use at 6 months and 1 year is associated with use at 2 years.METHODSUsing a single-center, longitudinally maintained registry, the authors identified 87 patients who underwent ASD surgery from 2013 to 2017. Fifty-nine patients reported preoperative opioid use (37 high-dose [≥ 90 morphine milligram equivalents daily] and 22 low-dose use). The duration of preoperative use was long-term (≥ 6 months) for 44 patients and short-term for 15. The authors evaluated postoperative opioid use at 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. Multivariate logistic regression was used to determine associations of preoperative opioid use, dose, and duration with use at each time point (alpha = 0.05).RESULTSThe following preoperative factors were associated with opioid use 2 years postoperatively: any opioid use (adjusted odds ratio [aOR] 14, 95% CI 2.5–82), high-dose use (aOR 7.3, 95% CI 1.1–48), and long-term use (aOR 17, 95% CI 2.2–123). All patients who reported high-dose opioid use at the 2-year follow-up examination had also reported preoperative opioid use. Preoperative high-dose use (aOR 247, 95% CI 5.8–10,546) but not long-term use (aOR 4.0, 95% CI 0.18–91) was associated with high-dose use at the 2-year follow-up visit. Compared with patients who reported no preoperative use, those who reported preoperative opioid use had higher rates of use at each postoperative time point (from 94% vs 62% at 6 weeks to 54% vs 7.1% at 2 years) (all p < 0.001). Opioid use at 2 years was independently associated with use at 1 year (aOR 33, 95% CI 6.8–261) but not at 6 months (aOR 4.3, 95% CI 0.95–24).CONCLUSIONSPatients’ preoperative opioid use, dose, and duration of use are associated with long-term use after ASD surgery, and a high preoperative dose is also associated with high-dose opioid use at the 2-year follow-up visit. Patients using opioids 1 year after ASD surgery may be at risk for long-term use.

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253. Factors associated with chronic opioid use in preoperative opioid nonusers following adult spinal deformity surgery

The Spine Journal ◽

10.1016/j.spinee.2019.05.268 ◽

2019 ◽

Vol 19 (9) ◽

pp. S123-S124

Author(s):

Andrew B. Harris ◽

Brian J. Neuman ◽

Alexandra Soroceanu ◽

Richard A. Hostin ◽

Themistocles S. Protopsaltis ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Opioid Use ◽

Factors Associated ◽

Spinal Deformity Surgery ◽

Chronic Opioid Use

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255. Preoperative opioid dosage and duration are associated with increased long-term opioid use after adult spinal deformity surgery

The Spine Journal ◽

10.1016/j.spinee.2019.05.270 ◽

2019 ◽

Vol 19 (9) ◽

pp. S125

Author(s):

Mark Ren ◽

Barry R. Bryant ◽

Andrew B. Harris ◽

Richard L. Skolasky ◽

Khaled M. Kebaish ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Opioid Use ◽

Spinal Deformity Surgery

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Clinical utility of enhanced recovery after surgery pathways in pediatric spinal deformity surgery: systematic review of the literature

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20444 ◽

2020 ◽

pp. 1-14

Author(s):

Zach Pennington ◽

Ethan Cottrill ◽

Daniel Lubelski ◽

Jeff Ehresman ◽

Kurt Lehner ◽

...

Keyword(s):

Systematic Review ◽

Spinal Deformity ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Reoperation Rate ◽

Review Of The Literature ◽

Patient Controlled Analgesia ◽

Pain Scores ◽

Spinal Deformity Surgery ◽

Quantitative Analyses

OBJECTIVESMore than 7500 children undergo surgery for scoliosis each year, at an estimated annual cost to the health system of $1.1 billion. There is significant interest among patients, parents, providers, and payors in identifying methods for delivering quality outcomes at lower costs. Enhanced recovery after surgery (ERAS) protocols have been suggested as one possible solution. Here the authors conducted a systematic review of the literature describing the clinical and economic benefits of ERAS protocols in pediatric spinal deformity surgery.METHODSThe authors identified all English-language articles on ERAS protocol use in pediatric spinal deformity surgery by using the following databases: PubMed/MEDLINE, Web of Science, Cochrane Reviews, EMBASE, CINAHL, and OVID MEDLINE. Quantitative analyses of comparative articles using random effects were performed for the following clinical outcomes: 1) length of stay (LOS); 2) complication rate; 3) wound infection rate; 4) 30-day readmission rate; 5) reoperation rate; and 6) postoperative pain scores.RESULTSOf 950 articles reviewed, 7 were included in the qualitative analysis and 6 were included in the quantitative analysis. The most frequently cited benefits of ERAS protocols were shorter LOS, earlier urinary catheter removal, and earlier discontinuation of patient-controlled analgesia pumps. Quantitative analyses showed ERAS protocols to be associated with shorter LOS (mean difference −1.12 days; 95% CI −1.51, −0.74; p < 0.001), fewer postoperative complications (OR 0.37; 95% CI 0.20, 0.68; p = 0.001), and lower pain scores on postoperative day (POD) 0 (mean −0.92; 95% CI −1.29, −0.56; p < 0.001) and POD 2 (−0.61; 95% CI −0.75, −0.47; p < 0.001). There were no differences in reoperation rate or POD 1 pain scores. ERAS-treated patients had a trend toward higher 30-day readmission rates and earlier discontinuation of patient-controlled analgesia (both p = 0.06). Insufficient data existed to reach a conclusion about cost differences.CONCLUSIONSThe results of this systematic review suggest that ERAS protocols may shorten hospitalizations, reduce postoperative complication rates, and reduce postoperative pain scores in children undergoing scoliosis surgery. Publication biases exist, and therefore larger, prospective, multicenter data are needed to validate these results.

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262. Opioid use prior to adult spinal deformity surgery is associated with decreased cost effectiveness: a matched cohort analysis

The Spine Journal ◽

10.1016/j.spinee.2020.05.674 ◽

2020 ◽

Vol 20 (9) ◽

pp. S129-S130

Author(s):

Breton Line ◽

Shay Bess ◽

Samrat Yeramaneni ◽

Richard A. Hostin ◽

Christopher P. Ames ◽

...

Keyword(s):

Cost Effectiveness ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Cohort Analysis ◽

Matched Cohort ◽

Opioid Use ◽

Spinal Deformity Surgery

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275. Opioid use after adult spinal deformity surgery: propensity-matched comparison of Japanese vs amAmerican cohorts

The Spine Journal ◽

10.1016/j.spinee.2020.05.377 ◽

2020 ◽

Vol 20 (9) ◽

pp. S137

Author(s):

Jeffrey L. Gum ◽

Leah Y. Carreon ◽

Mitsuru Yagi ◽

Naobumi Hosogane ◽

Kota Watanabe ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Opioid Use ◽

Spinal Deformity Surgery ◽

Matched Comparison

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119. Even acute preoperative opioid use before adult spinal deformity surgery associated with increased reoperations at five years

The Spine Journal ◽

10.1016/j.spinee.2020.05.225 ◽

2020 ◽

Vol 20 (9) ◽

pp. S58-S59

Author(s):

Andre Samuel ◽

Francis C. Lovecchio ◽

Ajay Premkumar ◽

Avani S. Vaishnav ◽

Han Jo Kim ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Opioid Use ◽

Spinal Deformity Surgery

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Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19814 ◽

2020 ◽

Vol 32 (3) ◽

pp. 423-431 ◽

Cited By ~ 3

Author(s):

Hiroki Ushirozako ◽

Go Yoshida ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Tatsuya Yasuda ◽

...

Keyword(s):

Spinal Deformity ◽

False Positive ◽

Adult Spinal Deformity ◽

False Positive Rate ◽

Multivariate Logistic Regression Analysis ◽

Motor Evoked Potential ◽

Scoliosis Surgery ◽

True Negative ◽

Duration Of Surgery ◽

Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

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