158. Pain plan implementation for elective spine surgery: effect of patient opioid history categorization on inpatient and outpatient opioid use, length of stay, pain scores, and clinic resource utilization

Abstract

<h3>BACKGROUND CONTEXT</h3> Opioid use is common after spine surgery, posing serious risks. Past experience with opioid pain medication is variable for patients undergoing elective spine surgery, which may have an effect on pain management. <h3>PURPOSE</h3> To analyze if pain plan categorization based on prior opioid experience is predictive of opioid use, length of stay (LOS), patient-reported pain scores, and pain management related clinic resource utilization following elective spine surgery. <h3>STUDY DESIGN/SETTING</h3> In an effort to minimize opioid use, the Madison pain plan was developed and implemented for patients undergoing elective spine surgery at UW Health in Madison, WI. The pain plan was built collaboratively with patients preoperatively, based on prior patient opioid experience. The plan includes intraoperative, postoperative, and planned discharge pain management medications. Patients are categorized based on their previous opioid experiences as follows: Category 1 – no previous opioid experience; Category 2 – previous opioid experience with adequate pain control and no adverse side effects; Category 3 – previous opioid experience with unacceptable pain control and/or adverse side effects; Category 4 – currently taking opioids preoperatively. <h3>PATIENT SAMPLE</h3> The study population consisted of patients ≥ 18 years of age undergoing elective spine surgery with two surgeons during the study period. <h3>OUTCOME MEASURES</h3> Primary outcome measures were inpatient opioid quantities, outpatient opioid prescription quantities, LOS, patient-reported pain scores, as well as frequency and complexity of clinic communication encounters. <h3>Methods</h3> A retrospective cohort study was performed for the outcome measures in patients within the 4 different pain plan categories over a one-year period (n=313). Extensive demographic data was collected to confirm group comparison validity. A biostatistician performed all statistical analyses. <h3>Results</h3> A regression model was used to control for patient age, and surgeon covariates. There was no difference in LOS or complexity of communication encounters amongst groups. Inpatient and outpatient opioid use were statistically significant (p<0.001) amongst the categories, with prescription quantities being greatest in Category 4, followed by Categories 2, 3, and 1, respectively. Inpatient opioid use had statistically significant differences when comparing Category 1 vs 2, 1 vs 4, and 3 vs 4 and outpatient opioid prescription quantities had statistically significant differences when comparing Category 1 vs 4, 2 vs 4, and 3 vs 4. Patient-reported pain scores were also significant (p<0.001) when comparing Category 1 vs 4, 2 vs 4, and 3 vs 4, and followed the same trend as opioid quantities. The number of communication encounters was significant (p=0.006) for Category 3 vs 4 only. <h3>Conclusions</h3> The pain plan was developed to collaboratively address postoperative pain control with patients. We feel that this approach sets expectations and limits. We expected both Category 3 and 4 patients to have the greatest opioid consumption, but this proved to be true only for Category 4. Category 3 and 4 patients required substantially more effort to build the pain plan, and we believe this extra effort is responsible for Category 3 patients showing characteristics similar to Category 1 and 2 patients. pain plan categorization based on patient-reported opioid experience is an effective tool for postoperative pain management at our institution. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.