P71. Low dose versus high dose opioid prescriptions in addition to non-opiate analgesics in opioid naïve patients undergoing spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Medically prescribed opiates contribute to the opioid crisis, manifesting in significant mortality and economic burden. While opioids are a mainstay of pain amelioration, prescription practices among surgeons are heterogenous. This study sought to investigate the relationship between immediate postoperative opioid prescriptions and patient reported pain outcomes following spinal surgery. <h3>PURPOSE</h3> To investigate the relationship between immediate postoperative opioid prescriptions and patient reported pain outcomes at POD 30 following spinal surgery. <h3>STUDY DESIGN/SETTING</h3> Patients undergoing spine surgery from 2012-2018 at a tertiary care referral facility. The prescribed opioid dose was converted to morphine milligram equivalents (MME) per day using a standard reference table. Nonsteroidal anti-inflammatory drug (NSAID) or Acetaminophen regimen was classified as either low dose or high dose non-opiate analgesics based on the median doses currently prescribed. <h3>PATIENT SAMPLE</h3> Inclusion criteria included: (1) patients who had clinical follow-up with preoperative (preop), POD 1, and POD 25-35 (referred to as POD 30) pain scores reported on the visual analog scale (VAS); (2) patients who were discharged from the hospital in good health. A total of 1,428 patients met inclusion criteria. <h3>OUTCOME MEASURES</h3> (1) Postoperative day 30 (POD30) visual analog scale (VAS) pain score; (2) 50% reduction in patient reported pain score between preop and POD 30. <h3>METHODS</h3> Patients with previous history of opioid usage or those receiving treatment for malignancy, trauma, or infection were excluded. Patient reported pain outcomes at preoperative and various postoperative days were measured using the visual analog scale. Chi-square, Kruskal-Wallis, linear, and logistic regression were used to investigate associations between covariates and postoperative pain scores. <h3>RESULTS</h3> Results of our univariate and multivariable linear regression found a patient POD 1 VAS to be associated with POD 30 VAS scores (P<0.0001). Additionally, the lowest prescribed dose of opioids [0-40 MME/day] was found to be significantly associated with worsened POD30 VAS scores (P=0.019). However, when constructing a multivariable regression model accounting for a patient's multimodal analgesic regimen, the association between lowest opioid dosage (<40MME/day) and POD30 VAS pain scores was no longer significant when patients were co-prescribed high dose, non-opiate analgesics (P=0.752). Overall, patient-reported outcome scores assess a patient's perception of improvement after an intervention, traditionally focusing on improved pain and functional ability relative to preop. To address this, we investigated the relationship between prescribed opioid doses and the likelihood that a patient experienced at least 50% pain improvement from their preoperative VAS pain score. Notably, postop opioid prescription dosages were not significant predictors of patients who reported at least 50% pain improvement. <h3>CONCLUSIONS</h3> Our study found that patients receiving the lowest dosage of opioid prescriptions (<40MME/day) along with high dose non-opiate analgesics did not report worse pain relief at 30 days postoperatively compared to those receiving higher opioid dosages along with NSAIDs. In light of the current opioid epidemic, our study highlights a need to standardize postoperative opioids to the lowest effective prescription dose. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.