145. The impact of Michigan's new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC)

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Conference Proceeding

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The Spine Journal


BACKGROUND CONTEXT: In response to the opioid abuse epidemic, the state of Michigan passed new legislation designed to limit use of narcotics. Specific requirements included patient education with attestation, prescription system query, 7-day supply limit for acute pain, and a bona fide prescriber-patient relationship. The major aspects of these opioid laws were effective beginning July 1, 2018. PURPOSE: To evaluate the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery. STUDY DESIGN/SETTING: Patient data from 1 year prior to and 1 year after initiation of the new opioid laws were queried from the Michigan Spine Surgery Improvement Collaborative (MSSIC) database, a spine-specific registry. PATIENT SAMPLE: Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry. OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System (PROMIS) short form Physical Function (PF) 4a. METHODS: The MSSIC registry prospectively enrolls patients undergoing surgery for degenerative spine disease. Prior to and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated. Chi-square and t-tests were used to examine differences between pre and postopioid law implementation. RESULTS: Pre- and postopioid law patients had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3,783 (48.7%) to 2,698 (39.7%), P <.0001. At 3 months postoperatively, there were no differences in PROMIS PF (41.5 vs 41.8, P =.0789), minimum clinically important difference (56.0% vs 58.0%, P =.060), numeric rating scale (NRS) of back pain (3.5 vs 3.4, P =.1745, NRS of leg pain (2.7 vs 2.7, P =.6909), satisfaction (83.8% vs 84.0%, P =.763), or 90-day readmission rate (6.7% vs 6.4%, P =.3688) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (1.05% vs 1.48%, P =.0032). CONCLUSIONS: There was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.





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