Postoperative Pain and Healthcare Utilization Following Chiari Malformation Decompression: A Multicenter Retrospective Cohort Study

Introduction: Postoperative pain following Chiari malformation decompression is frequently severe and may contribute to substantial postoperative healthcare utilization. Although multimodal analgesic strategies are increasingly utilized across surgical specialties, postoperative pain management practices following Chiari decompression remain variable and poorly characterized. This exploratory retrospective study aimed to characterize postoperative analgesic practices and associated healthcare utilization outcomes following Chiari decompression. Methods: A retrospective cohort study was conducted of adult patients undergoing Chiari decompression across four institutions between 2016 and 2023. Postoperative analgesic regimens, including opioid and non-opioid medications, were recorded. Outcomes included postoperative pain scores, length of stay (LOS), postoperative imaging utilization, emergency department (ED) visits within 60 days of surgery, and readmissions. Results: Twenty-seven patients met inclusion criteria. Postoperative analgesic regimens were heterogeneous, with all patients receiving opioid medications and variable use of non-opioid adjuncts. Eleven patients (40.7%) presented to the ED during the postoperative period, most commonly for headache or pressure-related symptoms. These presentations frequently required additional pharmacologic management and diagnostic imaging, including computed tomography in 63.6% of cases and magnetic resonance imaging in 18.2%. Two patients were subsequently found to have cerebrospinal fluid leaks requiring operative intervention. Exploratory analysis demonstrated lower postoperative day 0 pain scores among patients receiving non-steroidal anti-inflammatory drugs (NSAIDs). Conclusions: Postoperative pain and healthcare utilization following Chiari decompression remain important clinical challenges. In this exploratory retrospective cohort, postoperative analgesic practices were variable, and a substantial proportion of patients required postoperative ED evaluation and additional imaging. These findings highlight the persistent postoperative symptom burden experienced by this patient population and may help inform future prospective evaluation of perioperative pain management pathways and postoperative care strategies following Chiari decompression.