The change in postoperative opioid prescribing after lumbar decompression surgery following state-level opioid prescribing reform

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  • 1 Center for Spine Health, Neurological Institute, and
  • | 2 Departments of Neurosurgery and
  • | 3 Orthopaedic Surgery, Cleveland Clinic;
  • | 4 Case Western Reserve University School of Medicine; and
  • | 5 Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
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OBJECTIVE

On August 31, 2017, the state of Ohio implemented legislation limiting the dosage and duration of opioid prescriptions. Despite the widespread adoption of such restrictions, few studies have investigated the effects of these reforms on opioid prescribing and patient outcomes. In the present study, the authors aimed to evaluate the effect of recent state-level reform on opioid prescribing, patient-reported outcomes (PROs), and postoperative emergency department (ED) visits and hospital readmissions after elective lumbar decompression surgery.

METHODS

This study was a retrospective cohort study of patients who underwent elective lumbar laminectomy for degenerative disease at one of 5 hospitals within a single health system in the years prior to and after the implementation of the statewide reform (September 1, 2016–August 31, 2018). Patients were classified according to the timing of their surgery relative to implementation of the prescribing reform: before reform (September 1, 2016–August 31, 2017) or after reform (September 1, 2017– August 31, 2018). The outcomes of interest included total outpatient opioids prescribed in the 90 days following discharge from surgery as measured in morphine-equivalent doses (MEDs), total number of opioid refill prescriptions written, patient-reported pain at the first postoperative outpatient visit as measured by the Numeric Pain Rating Scale, improvement in patient-reported health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System–Global Health (PROMIS-GH) questionnaire, and ED visits or hospital readmissions within 90 days of surgery.

RESULTS

A total of 1031 patients met the inclusion criteria for the study, with 469 and 562 in the before- and after-reform groups, respectively. After-reform patients received 26% (95% CI 19%–32%) fewer MEDs in the 90 days following discharge compared with the before-reform patients. No significant differences were observed in the overall number of opioid prescriptions written, PROs, or postoperative ED or hospital readmissions within 90 days in the year after the implementation of the prescribing reform.

CONCLUSIONS

Patients undergoing surgery in the year after the implementation of a state-level opioid prescribing reform received significantly fewer MEDs while reporting no change in the total number of opioid prescriptions, PROs, or postoperative ED visits or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions written for acute pain may decrease patient opioid exposure without negatively impacting patient outcomes after lumbar decompression surgery.

ABBREVIATIONS

CDC = Centers for Disease Control and Prevention; EMR = electronic medical record; MED = morphine-equivalent dose; NPRS = Numeric Pain Rating Scale; PDMP = prescription drug monitoring program; PRO = patient-reported outcome; PROMIS-GH = Patient-Reported Outcomes Measurement Information System–Global Health.
Figure from Funaba et al. (pp 308–319).

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Contributor Notes

Correspondence Robert D. Winkelman: Cleveland Clinic Foundation, Cleveland, OH. winkelr@ccf.org.

INCLUDE WHEN CITING Published online July 9, 2021; DOI: 10.3171/2020.11.SPINE201046.

Disclosures Dr. Mroz: royalties from Stryker. Dr. Steinmetz: royalties from Zimmer Biomet and Elsevier; consultant for Globus; and honoraria from Stryker and Globus.

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