Opioid Prescribing Trends Following Lumbar Discectomy

Background: Lumbar diskectomy is a common procedure, following which a brief course of narcotics is often prescribed. Nonetheless, increasing attention has been given to such prescribing patterns to limit adverse effects and the potential for abuse. This study investigated prescribing patterns of opioid within 90 days following lumbar diskectomy.

Methods: Patients undergoing single-level lumbar laminotomy/diskectomy from 2011 to 2021 were identified in the PearlDiver Mariner161 database. Exclusion criteria included the following: additional same-day spine procedures, age less than 18 years, same-day diagnosis of neoplasm, trauma, or infection, prior diagnosis of chronic pain, records active for less than 90 days following surgery, and filled opioid prescription between 7 and 30 days before the surgery. Predictors associated with receiving opioid prescriptions and excess prescribed morphine milligram equivalents (MMEs) were assessed with multivariable regression analyses. Prescribing patterns over the years were then analyzed with simple linear regression and compared for 2011 and 2021.

Results: A total of 271,631 patients met the inclusion criteria. Opioids were prescribed for 195,835 (72.1%) and were independently associated with lower age, female sex, higher Elixhauser Comorbidity Index, and geographic region (P < 0.0001 for each). Greater MMEs were independently prescribed to those who were younger, had higher Elixhauser Comorbidity Index, and lived in specific geographic regions (P < 0.0001 for each). The proportion of patients receiving opioid prescriptions slightly increased over time (69.0% in 2011 to 71.0% in 2021), whereas a decrease was observed in median MMEs prescribed (428.9 in 2011 to 225.0 in 2021, P < 0.0001) and mean number of prescriptions filled (3.3 in 2011 and 2.3 in 2021, P < 0.0001).

Conclusion: Following lumbar diskectomy, this study found clinical and nonclinical factors to be associated with prescribing opioids and prescribed MME. The decreased MME prescribed over the years was encouraging and the decreased number of prescriptions filled suggests that patients are not needing to return for more prescriptions than prior.