92. Opioid use after anterior cervical spine surgery: what is the appropriate prescription quantity?

BACKGROUND CONTEXT There is a lack of data informing opioid prescription quantities after ACDF or CDA. PURPOSE To record daily opioid use and pain levels after one- or two-level ACDF or CDA using an automated text-messaging based data collection system. STUDY DESIGN/SETTING Dual-institutional prospective observational study. PATIENT SAMPLE This study included 57 patients who underwent ACDF or CDA at one of two institutions (66.7% ACDF, 33.3% CDA; 64.6% one level, 35.4% two levels). OUTCOME MEASURES Daily opioid consumption, daily pain scores (NRS scale), initial prescription amount and type, number of pills left over, method of disposal, refill rate. METHODS All adult patients undergoing one- or two-level primary ACDF or CDA were enrolled at two high-volume institutions. Patients with daily opioid dependence were excluded, while those patients who utilized opioids on a non-daily basis in the 6 months before surgery were categorized as “intermittent opioid users.” Starting POD1, daily opioid use and pain scores were collected through a HIPAA-compliant, automated text-messaging system. To facilitate clinical applications, opioid use was converted from oral morphine equivalents (OME) into “pills” (oxycodone 5 mg equivalents). After 6 weeks or upon patient-reported cessation of opioid use, final survey questions were asked. Refill and prescription data were verified from the state registry. Risk factors for patients in top 25% of opioid use were analyzed. RESULTS A total of 48 patients completed the daily queries (84.2%). Average age of the patient sample was 50.2±10.9 years, with a BMI of 27.4±4.2 kg/m2. Thirty-two patients (66.7%) underwent ACDF and 10 CDA (33.3%); 64.6% one level and 35.4% two levels. In the six months before surgery, 18.8% used opioids on a non-daily basis. Total postdischarge opioid use ranged from 0-160 “pills” (oxycodone 5mg equivalents), median of 6.7 pills (IQR 0-30). Use did not vary between the one- and two-level groups (10 IQR [1.3-31.3] vs 4 pills IQR [0-18], respectively, p=0.085). Thirteen patients (27.1%) used no opioids after discharge. Out of those patients who took opioids, use dropped from median 2.6 pills POD1 to 1 pill POD5. By POD12, 91.4% stopped opioids. Only 6 patients (14.2%) obtained a refill. Preoperative intermittent opioid use was associated with the top 25% of opioid consumption (9.1% vs 50%, p=0.006). In all patients, pain scores declined from a median 6 on POD1 to 4 on POD7. CONCLUSIONS Most patients fall at the low end of the opioid-use spectrum, with a quarter taking no opioids postdischarge. A prescription equivalent to 10 oxycodone 5 mg pills (75 OME) would allow for pain relief while minimizing the number of leftover pills. Prescribing guidelines must reflect these numbers to avoid excess leftover pills in the home. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.