Introduction: Pain control following lumbar fusion represents a challenge for surgeons given the need to balance adequate analgesia versus the potential risk of developing opioid dependence. Our prior work has identified that continued opioid use at 90 days post-operative was a significant risk factor for continued opioid use at 1 and 2 years for patients undergoing lumbar fusion spine surgery. Thus, we set out to implement a statewide Morphine Milliequivalent (MME) post-operative prescribing cutoff. We aim to compare outcomes between opioid naïve patients based on whether they are prescribed opiates in compliance with our mandated threshold.
Methods: The Michigan Spine Surgery Improvement Collective (MSSIC) database was utilized to identify patients who underwent elective lumbar fusion after prescribing guidelines went into effect. We currently mandate 80% of opiate naïve patients undergoing 1 or 2-level lumbar fusion be prescribed 320 MME (45.7 daily/MME) or less over 7-days. Patients were grouped based on postoperative MME (≤320 vs. >320). Outcomes collected include opioid use, patient reported outcomes including MCID in pain, rate of return to work, and readmissions.
Results: A total of 4817 patients were included in this study, with a mandate compliance rate of 81.4%. Patients receiving ≤320 MME had significantly lower opioid use at 90 days (OR 0.56, CI 0.45-0.70, p< 0.001) compared to those receiving >320 MME. There was also a trend toward lower risk of 1-year opiate use (OR 0.71, CI 0.49-1.03, p=0.069). No significant differences were observed in patient satisfaction at 90 days or one year. Additionally, MCID outcomes for back and leg pain, return to work, readmission rates, and ED visits did not differ significantly between the two groups.
Conclusion : Patients receiving MME ≤320 following lumbar fusion surgery had significantly lower opioid use at 90-days with a trend toward lower use at 1-year. Notably, there was no difference in readmission, ED utilization, or patient satisfaction which demonstrates that lower opiate prescribing for lumbar fusions does not lead to unintended consequences related to inadequate analgesia.
.jpg)
