Objective: The aim of this study was to describe the effect of opioid prescribing guideline implementation for elective spine surgery cases on prescribing and consumption behaviors in a multisite academic hospital system. The effectiveness of an automated text messaging system as a tool to monitor postoperative opioid use and pain outcomes and inform guideline development and deployment is also evaluated.
Methods: The authors conducted a prospective study of postoperative opioid use behaviors and patient-reported outcomes for 2101 elective spine surgery cases between December 2018 and March 2022, prior to and following the implementation of opioid-prescribing guidelines in February 2021 at three urban hospital sites within a large academic health system. Opioid-prescribing guideline development was based on patient-reported opioid consumption behaviors monitored using a two-way text messaging platform in the perioperative and postoperative settings; its implementation involved standardized indication-specific discharge pain medication dosing. Opioid prescription and consumption trends were compared between pre-guideline and post-guideline implementation cases.
Results: The overall response rate to the automated text messaging system was 50.2% when evaluating all elective spine surgery cases. There were significant reductions in the mean postsurgical opioid prescription for thoracolumbar laminectomies and fusions (p < 0.001) after guideline implementation. There was no difference in mean cumulative postsurgical opioid consumption by operative procedure after guideline implementation. Prior opioid use (OR 1.81, 95% CI 1.05-3.03; p < 0.05) and the aggregate 12-week mean pain score (OR 1.20, 95% CI 1.07-1.35; p < 0.05) were significant predictors of elevated opioid use.
Conclusions: Opioid-prescribing guideline development for elective spine surgery cases that is informed by patient-reported opioid behaviors using a text messaging platform might reduce opioid volume prescribed by the operative procedure.
Keywords: fusion; laminectomy; opioids; pain; prescribing guidelines; spine surgery; text messaging.