Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

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  • 1 Departments of Neurosurgery and
  • 7 Orthopaedic Surgery, University of Michigan, Ann Arbor;
  • 2 Department of Neurosurgery, Henry Ford Hospital, Detroit;
  • 3 Center for Health Policy and Health Service Research and
  • 4 Public Health Sciences Department, Henry Ford Health System, Detroit;
  • 5 Department of Orthopaedic Surgery, Beaumont Health, Troy; and
  • 6 Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan
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OBJECTIVE

In 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.

METHODS

Patient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.

RESULTS

Patients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).

CONCLUSIONS

There was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

ABBREVIATIONS ASA = American Society of Anesthesiologists; MAPS = Michigan Automated Prescription System; MCID = minimum clinically important difference; MME = morphine milligram equivalent; MSSIC = Michigan Spine Surgery Improvement Collaborative; NRS = numeric rating scale; PF = Physical Function; PHQ-2 = 2-item Patient Health Questionnaire; PRO = patient-reported outcome; PROMIS = Patient-Reported Outcomes Measurement Information System.

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Contributor Notes

Correspondence Paul Park: University of Michigan, Ann Arbor, MI. ppark@med.umich.edu.

INCLUDE WHEN CITING Published online December 11, 2020; DOI: 10.3171/2020.7.SPINE20729.

Disclosures Dr. Oppenlander reports being a consultant for Globus Medical, DePuy Spine, and LifeNet Health. Dr. Park reports being a consultant for Globus and NuVasive; receiving royalties from Globus; and receiving grants paid to his institution from DePuy and the International Spine Study Group. Dr. Chang reports being a consultant to Globus Medical and receiving clinical or research support for the study from Blue Cross Blue Shield of Michigan. Dr. Schwalb reports receiving support of non–study-related clinical or research effort from Medtronic, Neuros, and StimWave; being a consultant for NeuroPoint Alliance and Jackson & Campbell, PC; and receiving salary support from Blue Cross Blue Shield of Michigan for his role as co-director of MSSIC. Dr. Abdulhak reports being a consultant for SeaSpine and Ulrich Medical USA. Dr. Perez-Cruet reports direct stock ownership in Thompson MIS. Dr. Aleem reports being an executive member of the MSSIC Committee.

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