For a study, researchers wanted to see if an institutional opioid prescribing policy following one or two-level lumbar fusion had any effect on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The previous study had shown that high levels of opioid prescribing may be linked to a desire to provide better patient satisfaction. Patients who received one or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single facility were studied retrospectively using prospectively obtained data. Patients who filled out the entire survey were included in the study. Patients with a history of trauma, fracture, spinal deformity, more than 2 level fusions, or prior lumbar fusion surgery L3-S1 were excluded from the study. The cohorts were determined by the date of surgery in relation to the start of an institutional opioid reduction policy on October 1, 2018. Opioid prescriptions were translated into milligram morphine equivalents to make comparisons easier (MME). There were 330 patients who met the criteria for inclusion: 259 per the protocol and 71 post-protocol. 256 one-level fusions and 74 two-level fusions were included in the study. Except for the number of patients who saw the pain management service, which increased from 36.7% (95) per protocol to 59.2% (42) post-protocol; P less than 0.001, there were minimal statistically significant variations between groups in terms of patient demographics (P>0.05). The EBL fell from (533 ± 571 mL) to (346 ± 328)mL (P=0.003). The proportion of patients with a concurrent laminectomy fell from 71.8% to 49.3% (P<0.001). The average opioids prescribed on discharge in the per-protocol period were (534 ± 425) MME, compared to (320 ± 174) MME after the procedure (P<0.001). As per (4.49 ± 0.85) per-protocol vs. (4.51 ± 0.82) post-protocol (P=0.986), there was no statistically significant difference in pain control satisfaction. After one or two-level lumbar fusion, a reduction in opioids administered at discharge was not related to any statistically significant change in patient satisfaction with pain treatment, as judged by the HCAHPS survey.
Link:journals.lww.com/spinejournal/Abstract/2022/01010/Reducing_Postoperative_Opioid_prescribing.7.aspx
