Rush Spine Docs Honored With Best Paper Award

Another top award for the researchers at Midwest Orthopedics at Rush in Chicago. They are the 2017 winner of the “Best Paper” award at the recently concluded meeting of the International Society for the Advancement of Spine Surgery (ISASS).

Their paper tackled the tough question of: does a higher ASA (American Society of Anesthesiologists) Score mean more pain and narcotics use after spinal fusion?

Their answer: not necessarily.

Ankur Narain, research coordinator for Kern Singh, M.D., was first author on the unpublished paper, “Inpatient Pain Scores and Narcotic Utilization Based on American Society of Anesthesiologists Score after Cervical and Lumbar Spinal Fusion.”

Ankur Narain told OTW, “The ASA classification is a widely utilized operative risk stratification tool in many surgical fields. However, research regarding the ASA classification in spine surgery populations is lacking. Our research group is also very interested in patient pain and postoperative narcotics consumption, as issues regarding narcotics dependence are increasingly prevalent. We thought it would be interesting to perform a study examining if a relationship existed between the ASA classification and postoperative pain and narcotics use during a patient’s inpatient stay after spinal fusion procedures.”

The researchers used a prospective surgical database of patients who underwent either a single-level, primary anterior cervical discectomy and fusion (ACDF) or minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for degenerative pathology between 2005-2016.

The authors wrote, “After exclusion of patients with incomplete preoperative pain scores, a total of 604 patients were included in this analysis; 211 (34.93%) underwent ACDF and 393 (65.07%) underwent MIS TLIF. Of the patients who underwent ACDF, 184 (87.20%) had an ASA score ≤ 2 and 27 (12.80%) had an ASA score > 2. ACDF patients with an ASA score > 2 were older (58.22 vs 46.31 years, p< 0.001), had lower rates of obesity (40.74% vs 63.04%, p=0.027), and had longer duration of hospital stay (38.50 vs. 28.15 hours, p=0.004). There were no differences in inpatient Visual Analogue Scale (VAS) pain scores or inpatient narcotic consumption between cohorts on any postoperative day (p>0.05 for each).”

“Of the patients who underwent MIS TLIF, 314 (79.90%) had an ASA ≤ 2 and 79 (20.10%) had an ASA score > 2. MIS TLIF patients with an ASA Score > 2 were older (59.75 vs 51.21 years, p< 0.001), had higher rates of obesity (64.56% vs 41.53%, p< 0.001), and had longer duration of hospital stay (69.18 vs. 56.42 hours, p=0.011). There were no significant differences in inpatient VAS pain scores or inpatient narcotic consumption between cohorts on any postoperative day (p>0.05 for each).”

Ankur Narain told OTW, “We were surprised to find that ASA score was not associated with differences in postoperative pain and narcotics consumption after spinal fusion procedures. This was surprising in that previous studies in other fields had demonstrated that ASA score is a predictor for postoperative complication incidence.”

“ASA score is not a predictor of postoperative pain and narcotics use after spinal fusion procedures, and postoperative analgesic protocols should not be altered based on ASA score. More work is necessary to analyze long-term narcotics use and narcotics dependence in patients undergoing spinal fusion procedures.”