Opioid Prescribing Patterns For Adolescents Undergoing Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A...

As the opioid crisis has evolved from prescription drug abuse to illicit fentanyl use, research has identified leftover surgical medications as still being a significant source of misuse. While the CDC provides quantitative opioid prescribing benchmarks for adults, discrete numerical targets for the pediatric and adolescent populations remain poorly defined. This study evaluates longitudinal trends in opioid prescribing patterns for adolescents undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) across a large, multi-site healthcare system.

We conducted a retrospective review of electronic medical records from eight pediatric hospitals for patients with AIS undergoing primary PSF from January 1, 2018, to August 1, 2024. Opioid-naïve patients with a valid discharge opioid prescription were included (n=1,034). Primary outcomes included total morphine milligram equivalents (MME) per prescription, maximum morphine milligram equivalents daily (MMED), the number of doses prescribed, and the 30-day refill rate. Statistical trends over time were analyzed using Kruskal-Wallis and Cochran-Armitage tests.

The cohort was 76% female with a mean age of 15.4 ± 2.07 years. Oxycodone accounted for 94% of initial prescriptions. From 2019 to 2024, there was a statistically significant decrease in the mean total MME prescribed per patient (321.4 mg to 200.7 mg, p < 0.001). This decline was primarily driven by a reduction in the number of doses (35.2 to 24.0, p < 0.001) rather than the MME per dose. The proportion of patients receiving <50 MMED increased significantly from 68% to 82% (p = 0.003), while only 5% of the total cohort exceeded the 90 MMED adult threshold. The overall refill rate was 14% and remained stable throughout the study period despite the reduction in initial prescription volumes. Significant variability in prescribing quantities was observed between the eight study sites (p < 0.05).

Total opioid MME prescribing for adolescent PSF has significantly decreased, mainly due to reduction in total quantity over the duration of the study without a concomitant increase in refills. However, the inter-site variability between sites underscores the need for standardized, evidence-based, and procedure-specific quantitative guidelines for PSF to optimize postoperative pain management while minimizing unused opioids.