• Joon S Yoo, Thomas S Brundage, Nadia M Hrynewycz, and Kern Singh.
• Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
• Spine. 2019 Nov 15; 44 (22): 1558-1563.

Study DesignRetrospective.ObjectiveTo examine the relationship between American Society of Anesthesiologists (ASA) score and inpatient pain and narcotics consumption following anterior cervical discectomy and fusion (ACDF).Summary Of Background DataHigher ASA scores have been previously linked to increased postoperative complication rates, healthcare costs, length of stay, and hospital readmissions. However, to our knowledge, there have not been previous investigations into the association between ASA scores and postoperative inpatient pain and narcotics utilization following ACDF.MethodsPatients who underwent a single-level, primary ACDF were retrospectively reviewed and stratified into two cohorts based on ASA score less than or equal to 2 or ASA score more than 2. ASA score was tested for association with demographic variables and perioperative characteristics using student's t test, chi-squared analysis, and Fisher exact test. Inpatient pain scores and narcotics consumption on each postoperative day were then compared between cohorts using bivariate linear regression.ResultsTwo hundred eleven patients who underwent ACDF were included: 184 had an ASA score less than or equal to 2 and 27 had an ASA score more than 2. Higher ASA score was associated with older age, higher comorbidity burden as measured by the modified Charlson Comorbidity Index (CCI), and lower prevalence of obesity. Higher ASA scores were associated with longer duration of hospital stay, while other perioperative characteristics were similar between ASA score cohorts. There were no differences in inpatient Visual Analog Scale (VAS) pain scores, or hourly, daily, and cumulative inpatient narcotic consumption between cohorts on any postoperative day.ConclusionThis retrospective investigation demonstrated that a higher ASA score is associated with increased operative time following ACDF. However, ASA score was determined not to be an independent risk factor that can predict postoperative pain or narcotics consumption among patients who undergo ACDF. Therefore, postoperative pain in the inpatient setting can be managed with similar modalities regardless of ASA score for patients undergoing ACDF.Level Of Evidence3.

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