Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery. Issue 6 (31st March 2020)

• Record Type: Journal Article
• Authors: Joo, Sarah S; Hunter, Oluwatobi O; Tamboli, Mallika; Leng, Jody C; Harrison, T Kyle; Kassab, Kate; Keeton, Jody D; Skirboll, Stephen; Tharin, Suzanne; Saleh, Emam; Mudumbai, Seshadri C; Wang, Rachel R; Kou, Alex; Mariano, Edward R
• Is Part Of: Regional anesthesia and pain medicine. Volume 45:Issue 6(2020)
• Page Start: 474
• Page End: 478
• Publication Date: 2020-03-31
• Subjects: opioids, adverse effects -- acute pain -- postoperative pain; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2020-101324
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and objectives: At our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery. Methods: In this retrospective cohort study, we identified all consecutive elective primary spine surgery cases 1 year before and after introduction of the protocol. This protocol used the patient's prior 24-hour inpatient opioid consumption to determine discharge opioid pill count and tapering schedule. The primary outcome was total opioid dose prescribed in oral MME from discharge through 6 weeks. Secondary outcomes included in-hospital opioid consumption in MME, hospital length of stay, MME prescribed at discharge, opioid refills, and rates of minor and major adverse events. Results: Eighty-three cases comprised the final sample (45 preintervention and 38 postintervention). There were no differences in baseline characteristics. The total oral MME (median (IQR)) from discharge through 6 weeks postoperatively was 900 (420–1440) preintervention compared with 300 (112–806) postintervention (p<0.01, Mann-Whitney U test), and opioid refill rates were not different between groups. There were no differences in other outcomes. Conclusions: This patient-specific prescribing and tapering protocol effectively decreases the total opioid dose prescribed for 6 weeks postdischarge after elective primary spine surgery. Our experience also demonstrates the potential generalizability of this protocol, which was originally designed for joint replacement patients, to other surgical populations.