Implementation of Statewide Opioid Prescribing Guidelines in Spine Surgery: A MSSIC Study

Area of Science:

• Orthopedic Surgery
• Pain Management
• Public Health

Background:

• The opioid epidemic necessitates strategies to prevent postoperative opioid dependency in spine surgery patients.
• Postoperative opioid use at 90 days is a risk factor for long-term opioid use.
• The Michigan Spine Surgery Improvement Collaborative introduced morphine milliequivalent (MME) prescribing guidelines in 2022.

Purpose of the Study:

• To evaluate the impact of implementing statewide MME prescribing guidelines on elective spine surgery outcomes.
• To assess the effectiveness of MME cutoffs in reducing postoperative opioid use and dependency.
• To determine if guideline implementation affects patient recovery, satisfaction, or adverse events.

Main Methods:

• Analysis of opioid-naïve patients undergoing elective cervical or lumbar spine surgery from the Michigan Spine Surgery Improvement Collaborative database.
• Grouping patients based on compliance with MME guidelines (≤225 MME for decompression, ≤320 MME for lumbar fusion).
• Multivariate analysis to assess the relationship between MME compliance and outcomes, controlling for confounders.

Main Results:

• MME compliance rates increased significantly post-implementation, ranging from 81.3% to 88.5%.
• MME cutoff compliance substantially reduced the risk of opioid use at 90 days (ORs 0.53-0.61) and at 1 year for lumbar fusion (OR 0.63).
• No significant differences were found in patient satisfaction, patient-reported outcomes, or adverse events.

Conclusions:

• This study is the first to demonstrate 1-year clinical outcomes following a statewide MME prescription cutoff for elective spine surgery.
• Statewide MME guidelines effectively reduce postoperative opioid dependency.
• Implementing opioid prescription cutoffs does not hinder patient recovery or negatively impact patient-reported outcomes.