Resident Physician University of Louisville Louisville, Kentucky, United States
Introduction: From 2000 to 2012, the incidence of polypharmacy almost doubled in the US. This increase was particularly notable in the prescription of muscle relaxants and analgesics. Even though a multitude of studies discuss the general adverse effects of polypharmacy, there exists a dearth of research related to long-term consequences of polypharmacy in lumbar spine degeneration. Polypharmacy is defined as the use of more than five prescription medications.
Methods: We performed a retrospective cohort analysis using Marketscan. Demographics and outcomes related to index hospital stay, post-operative complications, hospital admissions, outpatient services, medication refills, and cost at 6 months, 1 year, and 2 years after discharge were analyzed with inverse probability treatment weighting.
Results: Of the 148,768 patients with degenerative spine disease, 36% were diagnosed with spinal stenosis, 39% with disc herniation, 21% with protrusion and 4% with other degenerative conditions. In total, 82,713 of these patients engaged in polypharmacy. The index hospitalization stay for both polypharmacy and non-polypharmacy groups was 2 days with no significant difference in median index cost ($23,751 and $23,133 respectively, P=0.0019). 6 months, 1 year, and 2 years after initial discharge, polypharmacy patients were more likely to develop pneumonia, UTI’s, or sepsis (P < 0.0001). Polypharmacy patients were more likely to report depression and anxiety (P < 0.001) and to get admitted to the ED (P < 0.0001).
Polypharmacy patients were more likely to get re-admitted to the hospital compared to non-polypharmacy patients at 6 months, 1 year, and 2 years after initial discharge (P < 0.0001). 2-years after initial hospitalization, polypharmacy patients were paying a median of $36,471 compared to $13,093 that non-polypharmacy patients were paying for outpatient services and medication refills (P < 0.0001).
Conclusion : Even though there is no difference in the initial length of stay and hospitalization costs between polypharmacy and non-polypharmacy patients, patients engaging in polypharmacy were more likely to develop complications two years after surgery. Moreover, polypharmacy patients were more likely to get re-admitted, had increased ED visits, and utilized more outpatient services than their non-polypharmacy patients. Overall, polypharmacy patients had significantly higher costs associated with their care and medications two years after initial hospitalization.
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