Utilization of a Statewide Morphine Milliequivalent Prescribing Cutoff in Cervical Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Introduction: As providers, we have a responsibility to mitigate the potential for spine surgery patients to become dependent on opioid medications post-operatively. Our prior research has identified that continued opioid use at 90-days is a significant risk factor for continued opioid use at 1- and 2-years postoperatively for anterior cervical spine surgery patients. We currently mandate that 75% of opioid naïve patients be prescribed 225 MME or less for a 7-day script (32.14 MME/daily). The aim of this study is to evaluate outcomes of one to two-level anterior cervical surgery opioid-naïve patients with respect to our opioid prescribing guidelines.

Methods: The Michigan Spine Surgery Improvement Collective (MSSIC) database was utilized to identify opioid naïve patients who underwent anterior cervical surgery and prescribed postoperative opioids from January 2022 to May 2024. Patients were grouped based on compliance with our 225 MME guideline. Multivariate analysis was conducted to control for confounding variables. Outcomes collected include opioid use, patient satisfaction, MCID for neck, arm, back, and leg pain, return to work, readmission rates and ED visits.

Results: A total of 3,374 patients were included in this study, with a mandate compliance rate of 81.7%. Patients who were in the < 225 MME group had lower risk of opioid use at 90-days (OR 0.54, Cl 0.39-0.76, p< 0.001) compared to the high >225 MME group. There were trends towards reduced ED visits (OR 0.78, Cl 0.59-1.04, p=0.080) and opioid use at one year (OR 0.71, Cl 0.49-1.03, p=0.069) in the low MME group. No significant differences were observed for patient satisfaction, return to work, readmission rates, or MCID outcomes for arm, back, and leg pain

Conclusion : We demonstrate that the implementation of a statewide opioid prescribing cutoff for post-operative elective spine surgery patients is feasible and effective. Our findings suggest that lower postoperative opioid dosages may reduce opioid dependency without adversely impacting patient recovery.