Neurosurgery Resident Physician Dell Medical School at The University of Texas at Austin
Introduction: Prescription Drug Monitoring Programs (PDMPs) databases allow physicians to have real time information regarding a patient’s narcotic, sedative, and stimulant prescriptions. This study’s aim was to see how NARX scores correlated with patient reported outcomes (PROs) in patients who underwent one- or two-level lumbar fusions.
Methods: Retrospective analysis of patients who underwent a one- or two-level lumbar fusion.
Results: Two cohorts were created based on NARX score distribution. There were 98 patients in the NARX ≤ 200 and 69 patients in NARX > 200. The cohorts were similar in age and BMI, but the higher NARX cohort had more females and also had higher uses of nicotine, Marijuana and daily alcohol consumption than their counterparts. Both cohorts had very similar surgical data, but the higher NARX cohort consumed higher MMEs during their inpatient stay despite no difference in length of stay. Higher NARX score patients were more likely to have a diagnosed psychiatric diagnosis and visit the Emergency Department during their post-operative recovery period. While both groups reported improvements in their PROs, patients with lower NARX scores had a more improvement in ODI and VAS than patients with higher NARX scores. Lower NARX scores patients reported comparatively more improvement in the PROMIS PF, PI and SR domains.
Conclusion : Higher NARX scores in post-op one or two level lumbar fusion was associated with female sex and social history positive for nicotine, marijuana and daily alcohol consumption. These patients were significantly more likely to have a psychiatric diagnosis, consume more MME during inpatient recovery and visit the ED during their postop recovery. Lower NARX scores were associated with more significant improvement in disability and pain PROs. The results of this study support the pre-operative consideration of NARX score in conjunction with social histories and psychiatric comorbidities in the treatment decision making process. High NARX score patients should consider pre-operative optimization efforts such as opioid weaning, preoperative counseling, and other psychosocial support. Additionally, these data can be used in post-operative expectation management.
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