Resident Henry Ford Hospital Henry Ford Hospital Detroit, MI, US
Introduction: The Michigan Spine Surgery Improvement Collaborative (MSSIC) group set out to limit post-operative opioid dependency in Michigan by mandating a statewide discharge MME cutoff. In prior studies, we had found that continued opioid use at 90 days confers a higher risk for continued opioid use at 1- and 2-years. Thus, we implemented a statewide MME prescribing mandate that at least 80% of 1-2 level lumbar decompression patients must be discharged with a MME of ≤ 225 over 7-days (32.14 MME/daily). We aim to compare the effect of implementing this mandate on post-operative outcomes between opioid naïve patients.
Methods: A Michigan Spine Surgery Improvement Collaborative (MSSIC) database search was performed for 1 to 2 level lumbar decompression surgeries between January 2022 to May 2024. Patients were stratified by their postoperative opioid prescription (≤225 MME vs. >225 MME). Multivariate analysis was conducted to control for confounding variables.
Results: A total of 4,696 patients were included in the study, with a mandate compliance rate of 87.8%. A trend towards lower opioid use at 90 days (OR: 0.70, CI: 0.48-1.04, p= 0.067). There was no significant differences observed in patient satisfaction, return to work, or MCID outcomes for back and leg pain at either time point. Other outcomes, such as readmission rates (OR 1.06, CI: 0.71-1.65, p=0.772) and ED visits (OR 0.95, Cl: 0.72-1.27, p=0.731) were also not significantly different between the two groups.
Conclusion : We demonstrate that the utilization of a statewide opioid prescribing cutoff mandate for post-operative elective spine surgery patients is feasible and effective. Patients receiving ≤ 225 MME trended towards lower opioid use at 90 days, while at the same time there were no differences in adverse events or patient-reported outcomes. This demonstrates that an effective reduction of opioid use does not result in negative consequences for patients.
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