Narcotic Consumption Following Minimally Invasive Lumbar Decompression: A Comparison Between Hospital and Ambulatory-Based Surgery Centers

Background Several studies have compared outcomes between hospital-based centers (HBCs) and ambulatory surgery centers (ASCs) following minimally invasive lumbar decompression (MIS LD). However, the association between narcotic consumption and pain in the immediate postoperative period has not been well characterized. As such, this study aims to examine pain, narcotic consumption, and length of stay (LOS) among patients discharged on postoperative day 0 following a 1-level MIS LD between HBCs or ASCs.

Methods Patients who underwent a primary, 1-level MIS LD were retrospectively reviewed and stratified by operative location. Differences between groups in patient demographics were assessed using independent-sample t tests for continuous variables and χ² analysis for categoric variables. The operative location and its effect on perioperative characteristics, inpatient pain scores, and narcotics consumption were analyzed using multivariate linear regression adjusted for significant patient characteristics.

Results There were 235 patients identified, of whom 90 and 145 underwent surgery at an HBC or ASC, respectively. The HBC cohort exhibited an increased comorbidity burden and had a greater percentage of privately insured patients. The HBC cohort recorded shorter operative time and greater total estimated blood loss. Patients in the HBC cohort experienced prolonged LOS, and consumed greater total oral morphine equivalents compared with the ASC cohort. No differences were observed in the remaining outcomes.

Conclusions The results of the current study suggest that patients who underwent MIS LD at an ASC received fewer narcotics than patients treated at an HBC, which may contribute to shortened LOS. Additionally, there was no difference in patient-reported pain between cohorts despite the differences in narcotic use. As such, postoperative narcotics administration varied, indicating HBC patients perhaps required more narcotic pain medications to achieve the same pain scores that were sufficient enough to allow patient discharge, thus prolonging LOS.

Level of Evidence III