Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Global Spine Journal

Abstract

Introduction: Chronic opioid dependency in spine surgery is an ongoing concern given the ongoing opioid epidemic. We have previously reported on our cohort of opioid-naıve patients, however the literature has shown that patients with opioid use at baseline are at higher risk of less favorable outcomes. Starting in 2022, MSSIC instituted state-wide prescribing guidelines for opioid naıve patients undergoing one- or two-level lumbar decompression surgery (laminectomy, laminotomy, foraminotomy, microdiscectomy) with performance goals of 80% compliance. The goal of this study was to evaluate whether there would be a form of a “halo” effect on prescribing patterns for patients with baseline opioid use, who were not subject to the performance measure. Our hypothesis was that the change in prescribing patterns for the opioid naıve population would also translate to the non-naıve population as well. Material and Methods: The MSSIC database was queried from January 2022 to December 2024 for patients across 29 hospitals and ASCs who underwent elective lumbar decompression surgery and had a pre-operative opioid use history. Patients were grouped based on compliance with the MSSIC morphine milliequivalent (MME) post-operative prescribing cutoff for lumbar decompression: MME ≤ 225 (for a 7-day course). Outcomes analyzed at 90-days and 1-year included continued opioid use, post-operative complications, and patient reported outcomes (PROs) such as pain and functional scores. A multivariate analysis was conducted to control for confounders. Results: 9,240 patients were analyzed in this study. Prior to the study time frame, 59% of non-naıve patients were prescribed ≤ 225 MME, while after 74% patients were within this MME cutoff. Patients who were compliant with the MME cutoff were significantly less likely to have continued opioid use at 90 days and 1-year post-operative (OR 0.78; CI 0.62-0.98, p = 0.016 and OR 0.73; CI 0.56- 0.95, p = 0.009, respectively). Those who were compliant with the MME cutoff were also significantly more likely to achieve a minimal clinically important difference (MCID) in back pain at 90 days and 1-year post-operative (OR 1.44; CI 1.08-1.93, p = 0.007 and OR 1.48; CI 1.08-2.04, p = 0.008, respectively). There were no significant differences in ED visits, readmissions, or any complication. Conclusion: We demonstrate that the implementation of a multi-institutional opioid prescribing guidelines for an opioid naıve population has additive benefits for the non-naıve population. We observed a reduction in total opiates prescribed which was associated with decreased long-term opioid use despite patients’ pre-operative opioid use. Notably, this was achieved without deleterious effects related to inadequate analgesia such as increased adverse events, ED visits, or worsened PROs.

Volume

16

Issue

2 Suppl

First Page

758S

Comments

Global Spine Congress, May 27-30, 2026, Istanbul, Turkey

Last Page

759S

DOI

10.1177/21925682261435811

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