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Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience – Lumbar Spinal Stenosis

The article discusses the ongoing opioid epidemic and the efforts made by medical groups to develop prescribing guidelines to combat the crisis. A study conducted at a high-volume quaternary referral center evaluated postoperative opioid utilization 5 years after implementing an opioid-reduction protocol for common outpatient spinal procedures. The results showed a significant reduction in the quantity of narcotics prescribed over the years, with an average of 23.3 tablets per patient at discharge. The study concluded that a standardized discharge protocol can lead to long-term reductions in opioid discharge quantity without compromising patient safety or increasing hospital resources. This study provides evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest spinal centre on Harley Street UK

Published article

CONCLUSIONS: A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a…

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J Neurosurg. 2024 Apr 26:1-9. doi: 10.3171/2024.1.JNS232515. Online ahead of print. ABSTRACT OBJECTIVE: The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence,

J Neurosurg. 2024 Apr 26:1-9. doi: 10.3171/2024.1.JNS232515. Online ahead of print.

ABSTRACT

OBJECTIVE: The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors’ institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed. However, the ability to maintain the results garnered from such guidelines long term has not been described. The objective of this study was to evaluate postoperative opioid utilization at a high-volume quaternary referral center 5 years after the initial implementation of an opioid-reduction protocol for common outpatient spinal procedures.

METHODS: From the electronic medical records, authors collected data on the number of tablets and total morphine equivalent dose (MED) prescribed, acute postoperative readmissions for pain concerns, refill requests, and conversion to long-term opiate use in the 5 years following implementation of an opioid-reduction protocol for common outpatient spinal procedures. These procedures, undertaken in opiate-naive patients, included 1- or 2-level anterior cervical discectomy and fusion, 1- or 2-level cervical disc replacement, and 1- or 2-level laminectomy, laminotomy, or foraminotomy (cervical or lumbar).

RESULTS: The total quantity of narcotics was reduced by 37.0 tablets per patient after protocol implementation and over the 5-year period thereafter. Generally, patients were discharged with an average of 23.3 tablets, concurrent with the initial goal of 24 tablets, set forth in 2017. These results confirm an ongoing reduction in opiate quantities prescribed and overall morphine equivalent totals at the time of discharge over the course of 5 years after initial protocol implementation.

CONCLUSIONS: A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge.

PMID:38669713 | DOI:10.3171/2024.1.JNS232515

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Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience

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J Neurosurg. 2024 Apr 26:1-9. doi: 10.3171/2024.1.JNS232515. Online ahead of print. ABSTRACT OBJECTIVE: The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence

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