Opioid Prescription Trends Among Orthopaedic, Primary Care, and Pain Management Providers in Spine Surgery Patients.

Authors

• Delano Trenchfield
• Sebastian Fras
• Michael McCurdy
• Rajkishen Narayanan
• Yunsoo Lee
• Tariq Issa
• Gregory Toci
• Yazan Oghli
• Hassan Siddiqui
• Michael Vo
• Hamd Mahmood
• Meghan Schilken
• Bahram Pashaee
• John Mangan
• Mark Kurd
• Ian David Kaye
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

12-1-2024

Abstract

OBJECTIVE: To determine prescription trends across specialties in the perioperative care of patients undergoing spine surgery from 2018 to 2021.

SUMMARY OF BACKGROUND DATA: A range of measures, including implementation of state prescription drug monitoring programs, have been instituted to combat the opioid epidemic. Considering the continued presence of opioids for spine-related pain management, a better understanding of the patterns of opioid prescription practices may be important for future intervention.

METHODS: All patients aged 18 years and older who underwent elective posterior lumbar decompression and fusion, transforaminal lumbar interbody fusion, and anterior cervical diskectomy and fusion from 2018 to 2021 were retrospectively identified. Patient demographics and surgical characteristics were collected through a Structured Query Language search and manual chart review. Opioid prescription data were collected through Pennsylvania's Prescription Drug Monitoring Program (PDMP) database and grouped into the following prescriber categories: primary care, pain management, physiatry, and orthopaedic surgery.

RESULTS: Of the 1,062 patients, 302 (28.4%) underwent anterior cervical diskectomy and fusion, 345 (32.4%) underwent posterior lumbar decompression and fusion, and 415 (39.1%) underwent transforaminal lumbar interbody fusion. From 2018 to 2021, there were no significant differences in total opioid prescriptions from orthopaedic surgery ( P = 0.892), primary care ( P = 0.571), pain management ( P = 0.687), or physiatry ( P = 0.391) providers. Pain management providers prescribed the most opioids between 1 year and 2 months preoperatively ( P = 0.003), between 2 months and 1 year postoperatively ( P = 0.018), and overall ( P < 0.001).

CONCLUSION: Despite increasing national awareness of the opioid epidemic and the establishment of statewide prescription drug monitoring programs, prescription rates have not changed markedly in spine patients. Pain management and primary care physicians prescribe opioids at a higher rate in the chronic periods before and after surgery, likely in part because of longitudinal relationships with these patients.

LEVEL OF EVIDENCE: III.

STUDY DESIGN: Retrospective Cohort Study.

Volume

32

Issue

23

First Page

1252

Last Page

1252

ISSN

1940-5480

Published In/Presented At

Trenchfield, D., Fras, S., McCurdy, M., Narayanan, R., Lee, Y., Issa, T., Toci, G., Oghli, Y., Siddiqui, H., Vo, M., Mahmood, H., Schilken, M., Pashaee, B., Mangan, J., Kurd, M., Kaye, I. D., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., Kepler, C. K., … Schroeder, G. D. (2024). Opioid Prescription Trends Among Orthopaedic, Primary Care, and Pain Management Providers in Spine Surgery Patients. The Journal of the American Academy of Orthopaedic Surgeons, 32(23), e1252–e1259. https://doi.org/10.5435/JAAOS-D-24-00167

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

39186611

Department(s)

Administration and Leadership

Document Type

Article