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

Given the ongoing opioid epidemic, postoperative opioid dependency prevention in patients undergoing spine surgery is paramount. For these patients, postoperative opioid use at 90 days may be a significant risk factor of continued opioid use at 1 and 2 years. Since 2022, the Michigan Spine Surgery Improvement Collaborative has set postoperative, morphine milliequivalent (MME) prescribing guidelines for opioid-naïve patients undergoing cervical and lumbar spine surgery. This study evaluated how the implementation of these opioid prescription guidelines effect elective spine surgery outcomes.

Using the Michigan Spine Surgery Improvement Collaborative database, we identified opioid-naïve patients who underwent elective cervical or lumbar spine surgery and were prescribed postoperative opioids. Patients were grouped according to compliance with MME guidelines, ≤225 MME for cervical and lumbar decompression and ≤320 MME for lumbar fusion surgery. Multivariate analysis was conducted to examine independent relationships between MME cutoff compliance and patient outcomes, controlling for confounding variables. Outcomes included opioid use at follow-up, readmission, emergency department visit, return to work, and patient-reported outcomes related to satisfaction, physical function, and pain.

Fifteen thousand nine hundred and three patients were included. Postimplementation, MME compliance rates increased from 63.1%-71.4% to 81.3%-88.5%, depending on surgery type. For all surgeries, MME cutoff compliance significantly reduced the risk of opioid use at 90 days (odds ratio [OR] 0.53, CI 0.40-0.71, P < .001, OR 0.56, CI 0.40-0.77, P < .001, and OR 0.61, CI 0.50-0.74, P < .001, respectively), and at 1 year for lumbar fusion (OR 0.63, CI 0.48-0.84, P = .001). Importantly, no significant differences were observed in patient satisfaction, patient-reported outcomes, or adverse events.

We conducted the first study demonstrating 1-year clinical outcomes after implementing a statewide MME prescription cutoff in elective spine surgery. Our findings suggest that statewide opioid prescription cutoff guidelines for elective spine surgery can reduce postoperative opioid dependency without hindering patient recovery.