Assessing Pain Control and Satisfaction in Spine Surgery Amidst COVID-19 Staff Shortages: A Retrospective Study on...

Effective pain management is critical for recovery after spine surgery, as inadequate control can delay mobilization, prolong hospitalization, and raise opioid consumption.^1-4 Among the strategies available, patient-controlled analgesia (PCA) enables patients to self-administer intravenous opioids within preset safety limits. Inconsistencies in opioid use, pain scores, and length of stay suggest that the effectiveness of PCA may be shaped by contextual and institutional variables. One example being the significant strain the COVID-19 pandemic placed on hospital staffing and perioperative workflows, potentially undermining the effectiveness of provider-administered analge-sia.^9-10 Although postoperative pain management has been previously studied, few investigations have examined how pandemic-related staffing shortages may have impacted the comparative effectiveness of PCA versus non-PCA strategies.

This retrospective cohort study included 5,528 adult patients who underwent one of four spine procedures between January 2018 and December 2023. Patients were stratified by analgesia type (PCA vs. non-PCA) and time period (pre-COVID vs. post-COVID). Primary outcomes included total opioid consumption (measured in morphine milliequivalents, MME) and average Visual Analog Scale (VAS) pain scores in the first 24 hours postoperatively. Multivariable regression adjusted for demographics including age, sex, obesity, and smoking.

PCA use was associated with a 52.1% reduction in opioid consumption compared to non-PCA (p < 0.001). This effect was most pronounced post-COVID (74.2% reduction), though not statistically significant. Despite reduced opioid use, PCA patients reported slightly higher VAS scores (+0.814, p = 0.0013). Subgroup analyses revealed higher opioid use and pain scores among smokers and obese patients, while male sex predicted lower pain scores. PCA was particularly beneficial in more invasive procedures, and its expanded use in less complex surgeries post-COVID did not increase pain scores.

PCA significantly reduced opioid use following spine surgery, though pain scores were modestly higher. During staffing shortages, PCA may offer operational and clinical advantages. Patient-specific risk factors should guide individualized pain protocols.

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