• World Neurosurg · Feb 2021

    Limitations on Post-Operative Opioid Prescriptions and Effects on Healthcare Resource Utilization Following Elective Anterior Cervical Discectomy and Fusion.

    • Brice A Kessler, Brainard Burrus, Greeshma Somashekar, Samuel P Wurzelmann, and Deb Bhowmick.
    • Department of Neurosurgery, University of North Carolina School of Medicine, Durham, North Carolina, USA. Electronic address: Brice.Kessler@UNCHealth.unc.edu.
    • World Neurosurg. 2021 Feb 1; 146: e501-e508.

    ObjectiveTo curb the misuse of postoperative prescription opioids, the state of North Carolina enacted the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 limiting the duration of initial postoperative opioid prescriptions. The purpose of this study was to evaluate the STOP Act's effect on health care resource use by comparing patient outcomes and opioid prescribing practices following elective anterior cervical discectomy and fusion (ACDF).MethodsOutcomes and opioid prescribing data were retrospectively evaluated for Pre-Law (January 1, 2017, to December 31, 2017) and Post-Law (January 1, 2018, to December 31, 2018) elective 1- to 4-level anterior cervical discectomy and fusion patient cohorts. Outcome measures included hospital and clinic resource use in the form of emergency department visits, readmissions, major postoperative complications, number of clinic visits, or number of clinic phone calls by patients reporting uncontrolled pain or requesting new opioid prescriptions. Opioid-prescribing practices in the form of discharge prescription number of pills and total morphine milliequivalents also were recorded.ResultsSurrounding the STOP Act's implementation, there was no significant difference (P > 0.05) in emergency department visits, readmissions, major complications, number of postoperative clinic visits, or number of clinic phone calls for uncontrolled pain or new prescription requests. There was a significant decline in mean discharge prescription number of pills (89.7 vs. 67.0, P < 0.001), and average morphine milliequivalents (683.4 vs. 509.6, P < 0.001).ConclusionsThis may reflect overprescribing in this population, where larger opioid prescriptions were likely not needed to manage pain that would otherwise require a return to care.Copyright © 2020 Elsevier Inc. All rights reserved.

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