Patient Population
A total of 118,434 patients with degenerative spine disease (Table 1) receiving spinal surgery were included. Table 1. Cohort characteristics, polypharmacy is defined as having concurrently 5 or more of top 75% of medications.
|
|
|
All
|
Fusion with or without decompression
|
Decompression without fusion
|
Characteristics
|
No Polypharmacy (n=37682)
|
Polypharmacy (n=80752)
|
p-value
|
No Polypharmacy (n=16676)
|
Polypharmacy (n=44411)
|
p-value
|
No Polypharmacy (n =30909)
|
Polypharmacy (n=64748)
|
p-value
|
Age, Median ± MAD
|
52 ± 9
|
58 ± 9
|
<.0001
|
54 ± 9
|
56 ± 8
|
<.0001
|
52 ± 9
|
59 ± 9
|
<.0001
|
Gender, Female, n (%)
|
47%
|
55%
|
<.0001
|
54%
|
60%
|
<.0001
|
44%
|
54%
|
<.0001
|
Insurance
|
Commercial, %
|
71%
|
57%
|
<.0001
|
64%
|
60%
|
|
73%
|
55%
|
|
Medicaid, %
|
15%
|
13%
|
22%
|
15%
|
<.0001
|
12%
|
12%
|
<.0001
|
Medicare, %
|
14%
|
30%
|
14%
|
25%
|
|
15%
|
33%
|
|
Elixhauser index (# of comorbidities)
|
0, %
|
52%
|
38%
|
|
43%
|
37%
|
|
53%
|
38%
|
|
1, %
|
26%
|
33%
|
<.0001
|
26%
|
31%
|
<.0001
|
25%
|
33%
|
<.0001
|
2, %
|
13%
|
17%
|
|
16%
|
18%
|
|
12%
|
17%
|
|
3+, %
|
10%
|
12%
|
|
15%
|
14%
|
|
9%
|
12%
|
|
Specific Comorbidities
|
Anemia, %
|
8%
|
10%
|
<.0001
|
14%
|
14%
|
0.281
|
7%
|
10%
|
<.0001
|
Bleeding disorders, %
|
1%
|
2%
|
<.0001
|
2%
|
2%
|
0.5811
|
1%
|
2%
|
<.0001
|
COPD, %
|
6%
|
8%
|
<.0001
|
9%
|
8%
|
0.6916
|
6%
|
8%
|
<.0001
|
Diabetes, %
|
12%
|
20%
|
<.0001
|
15%
|
19%
|
<.0001
|
11%
|
21%
|
<.0001
|
Hypertension, %
|
35%
|
50%
|
<.0001
|
42%
|
51%
|
<.0001
|
34%
|
51%
|
<.0001
|
Obesity, %
|
9%
|
9%
|
0.7933
|
11%
|
10%
|
0.0004
|
8%
|
8%
|
0.8113
|
Morbid Obesity, %
|
4%
|
5%
|
<.0001
|
5%
|
6%
|
0.0112
|
4%
|
5%
|
<.0001
|
Smoking, %
|
14%
|
11%
|
<.0001
|
16%
|
13%
|
<.0001
|
13%
|
10%
|
<.0001
|
Weight Loss, %
|
0.30%
|
0.40%
|
0.0365
|
0.30%
|
0.40%
|
0.0941
|
0.30%
|
0.40%
|
0.0271
|
Diagnosis type
|
Spinal stenosis, %
|
30%
|
41%
|
|
34%
|
39%
|
|
31%
|
45%
|
|
Disk herniation, %
|
50%
|
34%
|
<.0001
|
29%
|
24%
|
<.0001
|
55%
|
37%
|
<.0001
|
Pertusion, %
|
19%
|
24%
|
|
36%
|
37%
|
|
13%
|
17%
|
|
Degeneration, %
|
0.40%
|
0.60%
|
|
1%
|
1%
|
|
0%
|
1%
|
|
Pre-surgery opioid use
|
# of opioids in 12 months
|
1-11, %
|
45%
|
63%
|
<.0001
|
37%
|
60%
|
<.0001
|
47%
|
65%
|
<.0001
|
12+, %
|
2%
|
22%
|
<.0001
|
3%
|
27%
|
<.0001
|
2%
|
20%
|
<.0001
|
Opioid dependent, %
|
0.80%
|
1.40%
|
<.0001
|
1%
|
2%
|
<.0001
|
0.60%
|
1.20%
|
<.0001
|
Of these patients, 80,752 met criteria for polypharmacy (68.1%), and 41% of those were diagnosed with spinal stenosis, 34% with disc herniation, and 24% with disc protrusion. Patients with spinal stenosis and disc protrusion were more likely to be taking 5 or more medications than those with disc herniation (p<0.0001). Polypharmacy was more likely observed in older patients (median age 58 vs 52 years, p<0.0001), females (55% vs 47%, p <.0001), and Medicare users (30% vs 14%, p<0.0001). More patients in the polypharmacy group had medical comorbidities with higher Elixhauser of 3 or more (12% vs 10%, p<0.0001). Subgroup analyses included those who received spinal fusion (n=61,087) with 44,411 in the polypharmacy group and 16,676 non-polypharmacy group as well as decompression alone (n=95,657) with 64,748 in the polypharmacy group an 30,909 without polypharmacy.
Index Hospitalization and Discharge Disposition
The regression adjusted length of hospital stay (accounting for specific comorbidities for patients with polypharmacy patients was 2.4 days and 1.4 days for non-polypharmacy patients (p<0.0001), and median index hospital payments were higher for the polypharmacy group ($29,348) versus the non-polypharmacy group ($23,388) (p<0.0001). Fewer patients with polypharmacy were discharged home compared to patients of the non-polypharmacy cohort (81% vs 80%, p=0.0205) (Table 2). Table 2. Healthcare utilization and cost outcomes. Multivariable regression-adjusted estimates are presented. They represent the effect of polypharmacy unconfounded by observed characteristics.
|
|
|
All
|
Fusion with or without decompression
|
Decompression without fusion
|
Outcomes
|
No Polypharmacy (n=37682)
|
Polypharmacy (n=80752)
|
p-value
|
No Polypharmacy (n=16676)
|
Polypharmacy (n=44411)
|
p-value
|
No Polypharmacy (n =30909)
|
Polypharmacy (n=64748)
|
p-value
|
Index hospital
|
|
|
|
|
|
|
|
|
|
|
Length of hospital stay, Median ± MAD
|
1.8 ± 0.5
|
2.4 ± 0.4
|
<.0001
|
3 ± 0
|
3 ± 0
|
0.125
|
2 ± 1
|
2 ± 0.5
|
<.0001
|
|
Index payment, Median ± MAD
|
23388 ± 5774
|
29348 ± 9264
|
<.0001
|
65707 ± 4432
|
63038 ± 5680
|
<.0001
|
19461 ± 3447
|
23564 ± 6378
|
<.0001
|
|
Discharge home, %
|
80%
|
81%
|
0.0205
|
79%
|
80%
|
0.0105
|
82%
|
83%
|
0.4466
|
6-months post-discharge
|
|
|
|
|
|
|
|
|
|
|
Had 1 or more emergency visits, %
|
41%
|
53%
|
<.0001
|
42%
|
53%
|
<.0001
|
38%
|
51%
|
<.0001
|
|
Had 1 or more hospital admissions, %
|
13%
|
22%
|
<.0001
|
12%
|
20%
|
<.0001
|
13%
|
23%
|
<.0001
|
|
Number of outpatient services, Median ± MAD
|
17 ± 5
|
31 ± 6
|
<.0001
|
23 ± 6
|
35 ± 5
|
<.0001
|
16 ± 5
|
30 ± 6
|
<.0001
|
|
Number of medication refills, Median ± MAD
|
4 ± 2
|
19 ± 2
|
<.0001
|
3 ± 3
|
21 ± 2
|
<.0001
|
4 ± 2
|
19 ± 2
|
<.0001
|
|
Overall payments, Median ± MAD
|
2310 ± 699
|
6523 ± 1058
|
<.0001
|
3190 ± 758
|
6983 ± 1114
|
<.0001
|
2166 ± 665
|
6427 ± 1024
|
<.0001
|
12-months post-discharge
|
|
|
|
|
|
|
|
|
|
|
Had 1 or more emergency visits, %
|
56%
|
68%
|
<.0001
|
58%
|
68%
|
<.0001
|
53%
|
66%
|
<.0001
|
|
Had 1 or more hospital admissions, %
|
23%
|
37%
|
<.0001
|
23%
|
34%
|
<.0001
|
23%
|
37%
|
<.0001
|
|
Number of outpatient services, Median ± MAD
|
31 ± 10
|
60 ± 11
|
<.0001
|
41 ± 12
|
67 ± 11
|
<.0001
|
29 ± 9
|
59 ± 11
|
<.0001
|
|
Number of medication refills, Median ± MAD
|
6 ± 3
|
37 ± 3
|
<.0001
|
6 ± 4
|
39 ± 4
|
<.0001
|
6 ± 3
|
36 ± 3
|
<.0001
|
|
Overall payments, Median ± MAD
|
4561 ± 1507
|
13804 ± 2217
|
<.0001
|
5967 ± 1622
|
14253 ± 2344
|
<.0001
|
4302 ± 1428
|
13659 ± 2136
|
<.0001
|
24-months post-discharge
|
|
|
|
|
|
|
|
|
|
|
Had 1 or more emergency visits, %
|
70%
|
81%
|
<.0001
|
69%
|
79%
|
<.0001
|
68%
|
80%
|
<.0001
|
|
Had 1 or more hospital admissions, %
|
35%
|
54%
|
<.0001
|
35%
|
51%
|
<.0001
|
34%
|
54%
|
<.0001
|
|
Number of outpatient services, Median ± MAD
|
58 ± 19
|
115 ± 21
|
<.0001
|
74 ± 22
|
127 ± 21
|
<.0001
|
54 ± 17
|
112 ± 20
|
<.0001
|
|
Number of medication refills, Median ± MAD
|
10 ± 6
|
71 ± 6
|
<.0001
|
10 ± 7
|
74 ± 7
|
<.0001
|
10 ± 6
|
70 ± 6
|
<.0001
|
|
Overall payments, Median ± MAD
|
9514 ± 3278
|
30288 ± 4615
|
<.0001
|
12041 ± 3619
|
30907 ± 4982
|
<.0001
|
9097 ± 3140
|
30168 ± 4460
|
<.0001
|
Health outcomes and complications
Postoperative outcomes of index hospitalization, 30 days, 6, 12, and 24 months are presented in Table 3, Table 4.
Table 3. Complications, mental health, adverse drug events, and opioid use outcomes during index hospitalization and first 30 days.
|
|
|
All
|
Fusion with or without decompression
|
Decompression without fusion
|
Complications
|
No Polypharmacy (n=37682)
|
Polypharmacy (n=80752)
|
p-value
|
No Polypharmacy (n=16676)
|
Polypharmacy (n=44411)
|
p-value
|
No Polypharmacy (n=30909)
|
Polypharmacy (n=64748)
|
p-value
|
Index Hospital
|
Acute kidney injury, %
|
1%
|
1%
|
|
1%
|
1%
|
|
1%
|
1%
|
|
Surgical Site Infection, %
|
0%
|
1%
|
0.0118
|
0%
|
0%
|
|
1%
|
1%
|
|
Cardiac Arrest, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Deep Vein Thrombosis, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Myocardial Infarction, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Pneumonia, %
|
4%
|
5%
|
<.0001
|
5%
|
5%
|
|
4%
|
5%
|
0.0008
|
Pulmonary Embolism, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Stroke, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Wound Dehiscence %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Urinary Tract Infection %
|
2%
|
2%
|
|
2%
|
2%
|
|
2%
|
2%
|
|
At least one of the above, %
|
16%
|
19%
|
<.0001
|
17%
|
20%
|
<.0001
|
14%
|
17%
|
<.0001
|
1-month outcomes
|
Acute kidney injury, %
|
0%
|
1%
|
0.0219
|
1%
|
1%
|
|
0%
|
0%
|
|
Surgical Site Infection, %
|
4%
|
6%
|
<.0001
|
4%
|
7%
|
<.0001
|
4%
|
6%
|
<.0001
|
Cardiac Arrest, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Deep Vein Thrombosis, %
|
2%
|
3%
|
<.0001
|
2%
|
3%
|
0.0044
|
1%
|
1%
|
|
Myocardial Infarction, %
|
0%
|
0%
|
|
0%
|
0%
|
|
0%
|
0%
|
|
Pneumonia, %
|
6%
|
7%
|
0.0009
|
6%
|
7%
|
0.0379
|
5%
|
6%
|
0.0013
|
Pulmonary Embolism, %
|
1%
|
1%
|
|
1%
|
1%
|
|
1%
|
1%
|
|
Stroke, %
|
1%
|
1%
|
|
0%
|
0%
|
|
0%
|
1%
|
0.0047
|
Wound Dehiscence %
|
1%
|
2%
|
<.0001
|
1%
|
2%
|
0.0001
|
1%
|
2%
|
0.0007
|
Urinary Tract Infection %
|
3%
|
4%
|
<.0001
|
3%
|
4%
|
0.0038
|
2%
|
3%
|
<.0001
|
At least one of the above, %
|
17%
|
24%
|
<.0001
|
19%
|
24%
|
<.0001
|
14%
|
20%
|
<.0001
|
Table 4. Complications, mental health, adverse drug events, and opioid use outcomes during index hospitalization and first 6 months, 12 months, and 24 months.
|
|
|
All
|
Fusion with or without decompression
|
Decompression without fusion
|
Outcomes
|
No Polypharmacy (n=37682)
|
Polypharmacy (n=80752)
|
p-value
|
No Polypharmacy (n=16676)
|
Polypharmacy (n=44411)
|
p-value
|
No Polypharmacy (n=30909)
|
Polypharmacy (n=64748)
|
p-value
|
6-month outcomes
|
Complications
|
Acute kidney injury, %
|
1%
|
2%
|
<.0001
|
1%
|
2%
|
0.0023
|
0.60%
|
0.90%
|
0.0001
|
Surgical Site Infection, %
|
5%
|
8%
|
<.0001
|
6%
|
8%
|
<.0001
|
5%
|
9%
|
<.0001
|
Cardiac Arrest, %
|
0%
|
0%
|
0.1052
|
0%
|
0%
|
0.8561
|
0%
|
0.00%
|
0.0417
|
Deep Vein Thrombosis, %
|
4%
|
6%
|
<.0001
|
4%
|
6%
|
<.0001
|
2%
|
4%
|
<.0001
|
Myocardial Infarction, %
|
1%
|
2%
|
<.0001
|
1%
|
2%
|
0.0129
|
1%
|
2%
|
<.0001
|
Pneumonia, %
|
14%
|
19%
|
<.0001
|
14%
|
18%
|
<.0001
|
12%
|
17%
|
<.0001
|
Pulmonary Embolism, %
|
1%
|
2%
|
<.0001
|
1%
|
2%
|
<.0001
|
1%
|
2%
|
<.0001
|
Stroke, %
|
2%
|
3%
|
<.0001
|
1%
|
2%
|
<.0001
|
2%
|
3%
|
<.0001
|
Wound Dehiscence %
Urinary Tract Infection %
|
2%
7%
|
3%
9%
|
<.0001
<.0001
|
2%
12%
|
4%
15%
|
<.0001
<.0001
|
2%
11%
|
3%
15%
|
<.0001
<.0001
|
At least one of the above, %
|
35%
|
46%
|
<.0001
|
50%
|
61%
|
<.0001
|
47%
|
60%
|
<.0001
|
Mental Health
|
Depression, %
Anxiety, %
|
16%
|
27%
|
<.0001
|
19%
|
29%
|
<.0001
|
15%
|
26%
|
<.0001
|
15%
|
23%
|
<.0001
|
16%
|
24%
|
<.0001
|
14%
|
21%
|
<.0001
|
Adverse Drug Events, n (%)
|
1%
|
2%
|
<.0001
|
1.60%
|
2.10%
|
0.0142
|
1%
|
2%
|
<.0001
|
Opioid Use
|
# of opioids in 12 months
|
1-11, %
|
19%
|
26%
|
<.0001
|
18%
|
24%
|
<.0001
|
19%
|
27%
|
<.0001
|
12+, %
|
10%
|
51%
|
<.0001
|
12%
|
52%
|
<.0001
|
10%
|
50%
|
<.0001
|
Opioid dependent, %
|
5%
|
6%
|
0.0027
|
6%
|
7%
|
0.2378
|
5%
|
7%
|
0.012
|
12-month outcomes
|
Complications
|
Acute kidney injury, %
|
2%
|
3%
|
<.0001
|
3%
|
4%
|
0.0023
|
2%
|
3%
|
<.0001
|
Surgical Site Infection, %
|
6%
|
10%
|
<.0001
|
6%
|
10%
|
<.0001
|
6%
|
11%
|
<.0001
|
|
Cardiac Arrest, %
|
0.10%
|
0.30%
|
0.0089
|
0%
|
0%
|
0.727
|
0.10%
|
0.20%
|
0.0026
|
Deep Vein Thrombosis, %
|
5%
|
7%
|
<.0001
|
5%
|
8%
|
<.0001
|
3%
|
5%
|
<.0001
|
Myocardial Infarction, %
|
1%
|
2%
|
<.0001
|
1%
|
3%
|
<.0001
|
1%
|
2%
|
<.0001
|
Pneumonia, %
|
23%
|
31%
|
<.0001
|
23%
|
29%
|
<.0001
|
22%
|
30%
|
<.0001
|
Pulmonary Embolism, %
|
2%
|
3%
|
<.0001
|
1%
|
2%
|
<.0001
|
1%
|
3%
|
<.0001
|
Stroke, %
|
3%
|
5%
|
<.0001
|
2%
|
4%
|
<.0001
|
3%
|
5%
|
<.0001
|
Wound Dehiscence %
Urinary Tract Infection %
|
2%
12%
|
4%
16%
|
<.0001
<.0001
|
3%
12%
|
5%
15%
|
<.0001
<.0001
|
2%
11%
|
4%
15%
|
<.0001
<.0001
|
At least one of the above, %
|
49%
|
61%
|
<.0001
|
50%
|
61%
|
<.0001
|
47%
|
60%
|
<.0001
|
Mental Health
|
Depression, %
Anxiety, %
|
22%
|
36%
|
<.0001
|
26%
|
38%
|
<.0001
|
21%
|
35%
|
<.0001
|
21%
|
32%
|
<.0001
|
22%
|
32%
|
<.0001
|
20%
|
30%
|
<.0001
|
Adverse Drug Events, n (%)
|
3%
|
5%
|
<.0001
|
4%
|
5%
|
0.0001
|
2%
|
5%
|
<.0001
|
Opioid Use
|
# of opioids in 12 months
|
1-11, %
|
23%
|
40%
|
<.0001
|
21%
|
37%
|
<.0001
|
24%
|
42%
|
<.0001
|
12+, %
|
4%
|
34%
|
<.0001
|
5%
|
38%
|
<.0001
|
3%
|
32%
|
<.0001
|
Opioid dependent, %
|
8%
|
11%
|
<.0001
|
10%
|
12%
|
0.017
|
8%
|
11%
|
<.0001
|
24-month outcomes
|
Complications
|
Acute kidney injury, %
|
6%
|
9%
|
<.0001
|
6%
|
9%
|
<.0001
|
6%
|
9%
|
<.0001
|
Surgical Site Infection, %
|
7%
|
12%
|
<.0001
|
7%
|
11%
|
<.0001
|
7%
|
12%
|
<.0001
|
Cardiac Arrest, %
|
0%
|
1%
|
<.0001
|
0%
|
0%
|
0.1033
|
0.20%
|
0.50%
|
<.0001
|
Deep Vein Thrombosis, %
|
6%
|
10%
|
<.0001
|
7%
|
10%
|
<.0001
|
5%
|
9%
|
<.0001
|
Myocardial Infarction, %
|
2%
|
5%
|
<.0001
|
3%
|
6%
|
<.0001
|
2%
|
5%
|
<.0001
|
Pneumonia, %
|
37%
|
48%
|
<.0001
|
37%
|
46%
|
<.0001
|
35%
|
46%
|
<.0001
|
Pulmonary Embolism, %
|
2%
|
4%
|
<.0001
|
3%
|
4%
|
<.0001
|
2%
|
4%
|
<.0001
|
Stroke, %
|
5%
|
8%
|
<.0001
|
5%
|
7%
|
<.0001
|
5%
|
8%
|
<.0001
|
Wound Dehiscence %
Urinary Tract Infection %
|
3%
19%
|
4%
26%
|
<.0001
<.0001
|
3%
19%
|
5%
24%
|
<.0001
<.0001
|
3%
18%
|
4%
25%
|
<.0001
<.0001
|
At least one of the above, %
|
64%
|
76%
|
<.0001
|
64%
|
74%
|
<.0001
|
63%
|
76%
|
<.0001
|
Mental Health
|
Depression, %
|
31%
|
48%
|
<.0001
|
35%
|
50%
|
<.0001
|
30%
|
48%
|
<.0001
|
Anxiety, %
|
29%
|
43%
|
<.0001
|
31%
|
43%
|
<.0001
|
28%
|
41%
|
<.0001
|
Adverse Drug Events, n (%)
|
4%
|
8%
|
<.0001
|
5%
|
8%
|
<.0001
|
4%
|
7%
|
<.0001
|
Opioid Use
|
# of opioids in 12 months
|
1-11, %
|
27%
|
54%
|
<.0001
|
26%
|
52%
|
<.0001
|
26%
|
54%
|
<.0001
|
12+, %
|
2%
|
25%
|
<.0001
|
2%
|
28%
|
<.0001
|
2%
|
24%
|
<.0001
|
Opioid dependent, %
|
14%
|
20%
|
<.0001
|
17%
|
21%
|
<.0001
|
14%
|
21%
|
<.0001
|
During index hospitalization, pneumonia 5% and 4% in the non-polypharmacy group (p<0.0001) and surgical site infection was present in 1% of patients with polypharmacy versus 0% in non-polypharmacy (p=0.0118).
In the first 30 days after discharge, surgical site infection was observed in 6% of those with polypharmacy and 4% of those without polypharmacy (p<0.0001), DVT was shown in 3% in polypharmacy and 2% of non-polypharmacy (p<0.0001), urinary tract infection in 4% for the polypharmacy group versus 3% without polypharmacy (p<0.0001), and acute kidney injury was found in 4% for polypharmacy and 3% in non-polypharmacy (p=0.0219), Table 3. At least one complication was observed in 24% for the polypharmacy group and 17% for the non-polypharmacy group (p<0.0001).
At 6 months, patients with polypharmacy were more likely to be diagnosed with pneumonia (19% vs. 14%), surgical site infection (8% vs. 5%), deep vein thrombosis (6% vs. 4%), stroke 3% vs. 2%), pulmonary embolism (2% vs. 1%), myocardial infarction (2% vs 1%), (p<0.0001), Table 4.
At 24 months, 48% with polypharmacy had pneumonia compared to 37% without polypharmacy (p<0.0001), urinary tract infection was seen in 26% of those with polypharmacy versus 19% without polypharmacy, surgical site infection was seen in 12% of those with polypharmacy and 7% in the non-polypharmacy group (p<0.0001), 10% with polypharmacy had DVT versus 5% without polypharmacy (p<0.0001), 8% with polypharmacy had stroke versus 5% without polypharmacy, myocardial infarction was observed in 5% with polypharmacy versus 2% without polypharmacy. Depression (48% vs 31%), anxiety (43% vs 29%) and adverse drug events (8% vs 4%) were also associated with those meeting criteria for polypharmacy compared with those who did not have concurrent polypharmacy at 6 months postoperatively (p<0.0001). At 24 months, opioid use disorder was observed in 20% of those with polypharmacy versus 14% of those in the non-polypharmacy group (p<0.0027).
Common Medication Prescriptions
The most commonly prescribed medication was hydrocodone in 60% of patients, with 95% of patients receiving any opioid medication, Table 5.
Table 5. Top 15 drugs and classes observed in patients with polypharmacy and lumbar degenerative conditions receiving spinal surgery
|
|
Rank
|
Drug Name
|
Percent of patient use
|
(n=80,752)
|
1
|
APAP/HYDROCODONE BITARTRATE
|
60.07%
|
2
|
APAP/OXYCODONE
|
36.55%
|
3
|
GABAPENTIN
|
34.52%
|
4
|
METHYLPREDNISOLONE
|
30.78%
|
5
|
AZITHROMYCIN
|
27.23%
|
6
|
CEPHALEXIN
|
26.46%
|
7
|
CYCLOBENZAPRINE
|
25.63%
|
8
|
PREDNISONE
|
25.47%
|
9
|
DIAZEPAM
|
25.11%
|
10
|
AMOXICILLIN
|
24.92%
|
11
|
HYDROCODONE BITARTRATE AND ACETAMINOPHEN
|
22.33%
|
12
|
CIPROFLOXACIN
|
20.9%
|
13
|
LISINOPRIL
|
18.22%
|
14
|
OMEPRAZOLE
|
16.87%
|
15
|
METHOCARBAMOL
|
16.42%
|
|
Rank
|
Therapeutic Class Name
|
Percent of patient use
|
(n=80,752)
|
1
|
Anal/Antipyr, Opioid Agonists
|
95.05%
|
2
|
Muscle Relax, Skeletal Centra
|
63.92%
|
3
|
Analg/Antipyr, Nonsteroid/Antiinflam
|
60.84%
|
4
|
Psychother, Antidepressants
|
53.7%
|
5
|
Adrenals & Comb, NEC
|
53.13%
|
6
|
Antihyperlipidemic Drugs, NEC
|
53.07%
|
7
|
ASH, Benzodiazepines
|
44.54%
|
8
|
Anticonvulsants, Misc
|
43.12%
|
9
|
Gastrointestinal Drugs Misc, NEC
|
40.38%
|
10
|
Antibiot, Penicillins
|
39.67%
|
11
|
Quinolones, NEC
|
38.47%
|
12
|
Antibiot, Erythromycin & Macrolide
|
35.65%
|
13
|
Cardiac, Beta Blockers
|
34.26%
|
14
|
Antibiot, Cephalosporin and Rel.
|
34.17%
|
15
|
Cardiac, ACE Inhibitors
|
31.71%
|
Gabapentin was the third most prescribed medication at 34% followed by methylprednisolone (30%) and azithromycin (27%). Cyclobenzaprine was the most common antispasmodic agent at 25%. The second most common medication class was muscle relaxants, prescribed to 64% of patients, followed by NSAIDs (60%) and antidepressants (54%).
Healthcare utilization and payments
Patients with polypharmacy were more likely to go to the emergency room and to be admitted at the hospital at six, twelve, and 24 months (p<0.0001). Median payments for index hospital admission at time of surgery were $29,348 for those with polypharmacy and $23,388 for the non-polypharmacy group (p<0.0001) with higher LOS associated with the polypharmacy group (2.4 versus 1.8 days) (p<0.0001). The number of outpatient services utilized and their payments were higher for patients with polypharmacy at 6, 12, and 24 months (p<0.0001). Polypharmacy patients were also more likely to request medication refills (p<0.0001) and had higher prescription drug payments for all evaluated time points (p<0.0001). The overall combined payments (Table 2) for inpatient and outpatient services and prescription medications six months after initial hospitalization discharge were $2,310 for non-polypharmacy patients compared to $6,523 for polypharmacy patients (p<0.0001). At 12 months after discharge, polypharmacy patients paid a combined median amount of $13,804 compared to $4,561 for the controls (p<0.0001). 24 months after initial hospitalization discharge, polypharmacy patients paid a median combined amount of $30,288 compared to $9,514 for non-polypharmacy patients (p<0.0001).