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Opioid prescribing practices after posterior spinal arthrodesis for adolescent idiopathic scoliosis

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A Correction to this article was published on 12 June 2020

This article has been updated

Abstract

Study design

Retrospective review.

Objective

To identify national trends in postoperative opioid prescribing practices after posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS).

Summary of background data

Opioids are an important component of pain management after PSF for AIS. Given the national opioid crisis, it is important to understand opioid prescribing practices in these patients.

Methods

Using a commercial prescription drug claims database, we identified AIS patients who underwent PSF from 2010 to 2016 and who were prescribed opioids postoperatively. An initial prescription at hospital discharge of ≥ 90 morphine milligram equivalents daily (MMED) was used to identify patients at risk of overdose according to the US Centers for Disease Control and Prevention (CDC) guidelines. Prescriptions for skeletal muscle relaxants were also identified. α = 0.05.

Results

We included 3762 patients (75% female) with a mean (± standard deviation) age of 15 ± 2.1 years. 56% of patients filled only 1 opioid prescription after discharge, and 44% had ≥ 1 refills. 91% of opioid prescriptions were for hydrocodone (median strength, 43 MMED; mean strength, 65 ± 270 MMED) or oxycodone formulations (median strength, 60 MMED; mean strength, 79 ± 174 MMED). 82% of prescriptions complied with CDC guidelines (< 90 MMED). Overall, 612 patients (16%) filled ≥ 1 prescription for skeletal muscle relaxants, the most common being cyclobenzaprine (45%) and methocarbamol (29%). The percentage of patients filling > 1 prescription declined from 54% in 2010 to 31% in 2016 (p < 0.001). The proportion of patients receiving prescriptions for ≥ 90 MMED was highest in the West (29%) and lowest in the South (16%) (p < 0.001).

Conclusion

Most opioid prescriptions after PSF in patients with AIS comply with CDC guidelines. Temporal and geographic variations show an opportunity for standardizing opioid prescribing practices in these patients.

Level of evidence

III.

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Change history

  • 12 June 2020

    The original version of this article unfortunately contained a mistake.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, JHOC 5223, 21287, USA

    Andrew B. Harris, Varun Puvanesarajah, Majd Marrache, Caleb P. Gottlich, Micheal Raad, Richard L. Skolasky, Paul D. Sponseller & Amit Jain

  2. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA

    Dolores B. Njoku

Authors
  1. Andrew B. Harris
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  2. Varun Puvanesarajah
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  3. Majd Marrache
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  4. Caleb P. Gottlich
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  5. Micheal Raad
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  6. Richard L. Skolasky
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  7. Dolores B. Njoku
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  8. Paul D. Sponseller
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  9. Amit Jain
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Contributions

AH: Conception/design, data analysis, writing/editing, final review/approval. VP: Conception/design, data analysis, writing/editing, final review/approval. MM: Conception/design, data analysis, writing/editing, final review/approval. CG: Writing/editing, final review/approval. MR: Data analysis, writing/editing, final review/approval. RS: Writing/editing, final review/approval. DN: Writing/editing, final review/approval. PS: Conception/design, writing/editing, final review/approval. AJ: Conception/design, writing/editing, final review/approval.

Corresponding author

Correspondence to Amit Jain.

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The authors have no conflicts of interest with respect to the authorship and/or publication of this article.

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The original version of this article was revised: The original version of this article unfortunately contained a mistake. The first name of the author “Micheal Raad” was incorrectly provided as “Michael” instead of “Micheal”.

The study was exempt from institutional review board approval.

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Harris, A.B., Puvanesarajah, V., Marrache, M. et al. Opioid prescribing practices after posterior spinal arthrodesis for adolescent idiopathic scoliosis. Spine Deform 8, 965–973 (2020). https://doi.org/10.1007/s43390-020-00127-z

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  • DOI: https://doi.org/10.1007/s43390-020-00127-z

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