Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today?
Background: The opioid epidemic in the US has led prescribers to reevaluate postoperative pain control particularly in the field of spine surgery, where postoperative analgesia requirements and consumption have historically been high. There is a need to mitigate the quantity of unused pills after su...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-12-01
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| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548422000889 |
| _version_ | 1811199366828916736 |
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| author | Lindsay D. Orosz Alexandra E. Thomson Tarek Yamout Fenil R. Bhatt Brandon Allen Thomas C. Schuler Rita Roy Christopher R. Good Colin M. Haines Ehsan Jazini |
| author_facet | Lindsay D. Orosz Alexandra E. Thomson Tarek Yamout Fenil R. Bhatt Brandon Allen Thomas C. Schuler Rita Roy Christopher R. Good Colin M. Haines Ehsan Jazini |
| author_sort | Lindsay D. Orosz |
| collection | DOAJ |
| description | Background: The opioid epidemic in the US has led prescribers to reevaluate postoperative pain control particularly in the field of spine surgery, where postoperative analgesia requirements and consumption have historically been high. There is a need to mitigate the quantity of unused pills after surgery by adjusting prescribing practices. Achieving the balance of pain control after surgery without overprescribing opioids may be accomplished by developing a modified approach to prescribing practices; however, there is a need to first understand the opioid requirements of the modern spine surgery patient with respect to their elective spine surgery. Therefore, the primary aim of this study was to determine the percentage of opioids not utilized at 90-days after elective spine surgery. Secondary aims were to identify differences in the percentage of unused opioids between surgical subgroups and preoperative opioid status, to determine factors associated with opioid utilization, and to estimate the distribution of opioids consumed to control pain up to the 90th percentile in each surgical subgroup. Methods: In this prospective, observational cohort study, adults undergoing elective spine surgery at a multi-surgeon, single center were prospectively enrolled and divided into subgroups: anterior cervical, lumbar decompression, and short-segment lumbar fusion. Prescribed MMEs were identified from prescriptions, consumed MMEs were obtained from pill counts, and the percent leftover was calculated. Distributions of MMEs consumed were analyzed to compare utilization between preoperative opioid users or non-users within each surgical subgroup. Results: Of 117 patients, 41.9% were preoperative opioid users. The percentage of unused opioids by surgical subgroup was: 45.4% cervical, 57.3% lumbar decompression, and 37.4% lumbar fusion (p=0.066). The percentage of unused opioids by preoperative opioid exposure was greater in the opioid non-users (58.0%) than users (28.4%, p<0.001)). Regression analysis showed that surgical subgroup and preoperative opioid exposure were associated with leftover opioids. Conclusions: At 90-days, the percentage of unused opioids was over 45% in this cohort of elective spine surgery patients and was nearly double in the group without preoperative opioid exposure. These results suggest the modern elective spine surgery patient is using less opioids than prescribed, supporting the conclusion that the number of MMEs prescribed can be reduced to minimize quantities of leftover pills available for diversion, without sacrificing the priority of appropriate postoperative pain control. |
| first_indexed | 2024-04-12T01:47:02Z |
| format | Article |
| id | doaj.art-3369ba22c01b47aea701e04be150a6f8 |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-12T01:47:02Z |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-3369ba22c01b47aea701e04be150a6f82022-12-22T03:53:02ZengElsevierNorth American Spine Society Journal2666-54842022-12-0112100185Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today?Lindsay D. Orosz0Alexandra E. Thomson1Tarek Yamout2Fenil R. Bhatt3Brandon Allen4Thomas C. Schuler5Rita Roy6Christopher R. Good7Colin M. Haines8Ehsan Jazini9National Spine Health Foundation, Reston, VA, United States; Corresponding author at: National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, United States.Virginia Spine Institute, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesNational Spine Health Foundation, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesNational Spine Health Foundation, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesVirginia Spine Institute, Reston, VA, United StatesBackground: The opioid epidemic in the US has led prescribers to reevaluate postoperative pain control particularly in the field of spine surgery, where postoperative analgesia requirements and consumption have historically been high. There is a need to mitigate the quantity of unused pills after surgery by adjusting prescribing practices. Achieving the balance of pain control after surgery without overprescribing opioids may be accomplished by developing a modified approach to prescribing practices; however, there is a need to first understand the opioid requirements of the modern spine surgery patient with respect to their elective spine surgery. Therefore, the primary aim of this study was to determine the percentage of opioids not utilized at 90-days after elective spine surgery. Secondary aims were to identify differences in the percentage of unused opioids between surgical subgroups and preoperative opioid status, to determine factors associated with opioid utilization, and to estimate the distribution of opioids consumed to control pain up to the 90th percentile in each surgical subgroup. Methods: In this prospective, observational cohort study, adults undergoing elective spine surgery at a multi-surgeon, single center were prospectively enrolled and divided into subgroups: anterior cervical, lumbar decompression, and short-segment lumbar fusion. Prescribed MMEs were identified from prescriptions, consumed MMEs were obtained from pill counts, and the percent leftover was calculated. Distributions of MMEs consumed were analyzed to compare utilization between preoperative opioid users or non-users within each surgical subgroup. Results: Of 117 patients, 41.9% were preoperative opioid users. The percentage of unused opioids by surgical subgroup was: 45.4% cervical, 57.3% lumbar decompression, and 37.4% lumbar fusion (p=0.066). The percentage of unused opioids by preoperative opioid exposure was greater in the opioid non-users (58.0%) than users (28.4%, p<0.001)). Regression analysis showed that surgical subgroup and preoperative opioid exposure were associated with leftover opioids. Conclusions: At 90-days, the percentage of unused opioids was over 45% in this cohort of elective spine surgery patients and was nearly double in the group without preoperative opioid exposure. These results suggest the modern elective spine surgery patient is using less opioids than prescribed, supporting the conclusion that the number of MMEs prescribed can be reduced to minimize quantities of leftover pills available for diversion, without sacrificing the priority of appropriate postoperative pain control.http://www.sciencedirect.com/science/article/pii/S2666548422000889OpioidPainOverprescribingPain managementSpine surgeryESR |
| spellingShingle | Lindsay D. Orosz Alexandra E. Thomson Tarek Yamout Fenil R. Bhatt Brandon Allen Thomas C. Schuler Rita Roy Christopher R. Good Colin M. Haines Ehsan Jazini Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? North American Spine Society Journal Opioid Pain Overprescribing Pain management Spine surgery ESR |
| title | Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? |
| title_full | Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? |
| title_fullStr | Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? |
| title_full_unstemmed | Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? |
| title_short | Opioid use after elective spine surgery: Do spine surgery patients consume less than prescribed today? |
| title_sort | opioid use after elective spine surgery do spine surgery patients consume less than prescribed today |
| topic | Opioid Pain Overprescribing Pain management Spine surgery ESR |
| url | http://www.sciencedirect.com/science/article/pii/S2666548422000889 |
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