P105. Opioid prescribing practices following posterior spinal fusion for adolescent idiopathic scoliosis

Abstract

BACKGROUND CONTEXT Opioid medications are an important component postoperative pain management following posterior spinal fusion in patients with Adolescent Idiopathic Scoliosis (AIS). In the face of growing concerns among caregivers, medical providers and policymakers regarding the opioid crisis in the United States, it is important to understand trends in opioid prescribing practices in AIS patients undergoing posterior spinal fusion. PURPOSE Our purpose was to demonstrate that significant regional variations exist in the US opioid prescribing practices after surgical treatment of AIS. STUDY DESIGN/SETTING Analysis of a commercial prescription drug database. PATIENT SAMPLE A total of 3,492 patients aged 10 to 21 with AIS who underwent surgical treatment with posterior spinal fusion from 2010 to 2016. OUTCOME MEASURES Our primary outcomes were the quantity and duration of opioid prescription postoperatively. METHODS Patients were included if they had prescription drug coverage and filled at least 1 opioid prescription upon discharge. Patients were excluded for: diagnosis of neuromuscular or congenital scoliosis; preoperative opioid use; and, readmission in the 6-month postoperative period. For each opioid prescription, morphine milligram equivalents (MMEs) were calculated. RESULTS Mean age of patients was 14±2 years; (75% girls). Fifty-six percent of patients filled a single prescription, while 44% had one or more refills. Ninety-nine percent of patients did not fill opioid prescriptions past 90 days postoperatively, 91% of opioid prescriptions were for either hydrocodone (median strength 43 MME/day) or oxycodone (median strength 60 MME/day) and 81% of all prescriptions complied with CDC guidelines of 90 MME/day was highest in the western US (30% of patients) and lowest in the southern US (16% of patients) (p CONCLUSIONS In the AIS population, significant regional variations exist in opioid prescribing practices for post-discharge pain control. There exists an opportunity for standardizing opioid prescribing practices in management of postoperative AIS patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.