Introduction:

Understanding post-surgical prescribing patterns and their impact on persistent opioid use is important for establishing reasonable opioid prescribing protocols. We aimed to determine national variation in postoperative opioid prescription practices following elective lumbar spine surgery and their impact on short-term refill prescriptions.

Methods:

The OptumLabs Data Warehouse (OLDW) was queried from 2016-2017 for adults undergoing anterior lumbar fusion (ALF), posterior lumbar fusion (PLF), circumferential lumbar fusion (CLF) and lumbar decompression and discectomies (LD) for degenerative spine disease. Discharge opioid fills were obtained and converted to morphine milligram equivalents (MMEs). Age and sex-adjusted MMEs and frequency of discharge prescriptions>200 MMEs were determined for each US census division and procedure type.

Results:

A total of 43,572 patients with 37,894 post-discharge opioid fills were included. There was wide variation in mean filled MMEs across all census divisions (ALF: 774-1147 MMEs, PLF: 717-1280 MMEs, CLF: 817-1271 MMEs and LD: 619-787 MMEs). A significant proportion of cases were found to have filled discharge MMEs>200 (PLF: 78.6% to 95%; ALF: 87.5%-95.6%; CLF: 81.4%-96.5%; LD: 80.5%-91%). Multivariable logistic regression showed that female sex and inpatient surgery were associated with a top-quartile discharge prescription and also a short-term second opioid fill, while the opposite was noted for elderly and opioid naive patients (all p≤0.05). Prescriptions with long-acting opioids were associated with higher odds of a second opioid fill, ref=Non-tramadol short-acting opioid).

Conclusions:

In analysis of filled opioid prescriptions, we observed significant proportion of prescriptions>200 MMEs and wide regional variation in post-discharge opioid prescribing patterns following elective lumbar spine surgery.