305. Differences between postoperative narcotic prescriptions in outpatient lumbar spine surgery between the United States and France

Abstract

BACKGROUND CONTEXT The United States is currently undergoing a major opioid crisis that has recently started to decrease its population's life expectancy due to over-mortality of its young citizens by drug overdose. Among the listed causes, physician narcotic prescriptions for both acute and chronic medical conditions are often pointed out as the main culprit for this crisis. PURPOSE We investigated the differences between discharge prescriptions following outpatient lumbar spine surgery between a French and a US spine surgery department. STUDY DESIGN/SETTING Multicenter comparative observational study. PATIENT SAMPLE A total of 100 age and sex-matched patients: 50 patients in the American center, 50 in the French center. OUTCOME MEASURES Amount of narcotics in MED (morphine equivalent dose) in the discharge prescription. Number of postoperative visits to the emergency room for inadequate pain control. METHODS Demographics, comorbidities, operative data, current prescriptions and discharge prescriptions were compared between the two groups. Narcotic consumption was converted in milligrams of morphine equivalent dose (mg MED). RESULTS A total of 25 American patients (50%) consumed narcotics preoperatively vs 4 French patients (8%). Only 22% of Americans were opioid naive. Postoperatively, all French patients had a narcotic-free prescription while all American patients were prescribed a significant amount of narcotics (617.04mg ± 345.16mg MED). One American patient returned to the emergency department for inadequate pain control while none of the French did. French patients were never prescribed steroids but had systematic nonsteroid inflammatory drugs while 41.4% of American patients were prescribed postoperative steroid tapers following a postoperative telephone call. CONCLUSIONS For identical surgeries, all American patients were prescribed postoperative narcotics while none of the French were. Cultural beliefs from both patients, physicians and the industry probably represent the most significant barrier against the implementation of a narcotic-free culture in our practice. Reducing narcotic prescriptions in our practice is not only feasible but also highly desirable. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.