Analysis of Opioid Prescription and Use trends Before and After Minimally Invasive Spine Surgery

Introduction: The opioid epidemic has raised concerns about prescription patterns. Minimally invasive surgeries (MIS) of spine are designed to reduce post-operative pain and recovery time; however, many patients still require postoperative opioids for an extended period of time. There are specific considerations regarding opioid prescriptions in patients after undergoing minimally invasive spine surgery. Understanding opioid prescription patterns and characteristics of patients is vital for reducing misuse and optimizing patient care.

Methods: We aim to analyze preoperative and postoperative opioid prescription patterns and clusters among patients treated with MIS spine surgeries.
A retrospective cohort of 2118 patients undergoing 1 or 2-level lumbar fusion, 1 or 2-level ACDF, and 1-level lumbar microdiscectomy at a single institution between 2018 to 2022 was studied. In-patient (except operative) opioid prescription data from 3 months before surgery (pre-surgery) to 1 year after surgery (post-surgery) date was studied. The number of opioid prescriptions, morphine milligram equivalents (MME), and duration of opiate prescription defined as days from surgery and the interquartile range (IQR) were calculated for patients pre- and post-surgery using R and standard morphine equivalent conversion factors.

Results: There were 1,747 pre-surgical and 7238 post-surgical opioid prescriptions identified amongst 2062 study participants. Median MME were identical in pre- and post-surgical patients [Pre-surgery:45, IQR:20-45; post-surgery:45 IQR:30-90]. Median number of opioid prescriptions [Pre-surgery: 1, IQR: 1-2; Post-surgery: 3, IQR: 1-7], maximum number of opioid prescriptions [Pre-surgery: 2, IQR: 1-4; Post-surgery: 7, IQR: 3-14], and duration of opioid prescription [Pre-surgery: 20 days, IQR: 0-47; Post-surgery: 41 days, IQR: 6-155] was higher post-surgery than pre-surgery.

Conclusion : Our analysis shows a significant increase in the duration of opioid prescription post-surgery versus pre-surgery, indicating that spine surgery potentially extends patients’ reliance on opioids for pain control rather than immediately eliminating dependence. A more extensive analysis will yield valuable insights into guidelines for optimizing postoperative opioid prescriptions.