Original Contribution  |   July 2019
Comparison of Lumbar Fusion for Back Pain and Opioid Use at County and Managed Care Hospitals
Author Notes
  • From the Department of Neurosurgery at Riverside University Health System in Moreno Valley, California (Drs Ghanchi, Miulli, Kashyap, Toor, Farr, Ray, and Sweiss); the Department of Neurosurgery at Arrowhead Regional Medical Center in Colton, California (Drs Miulli and Beamer); the Department of Neurosurgery at Kaiser Permanente Medical Center in Fontana, California (Dr Rao); and the College of Pharmacy at the University of Florida in Orlando (Dr Ashraf). 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Hammad Ghanchi, DO, MSc, Riverside University Health System, Neurological Surgery Residency Program, 26520 Cactus Ave, Moreno Valley, CA 92555-3927. Email: h.ghanchi@ruhealth.org
     
Article Information
Pain Management/Palliative Care / Opioids
Original Contribution   |   July 2019
Comparison of Lumbar Fusion for Back Pain and Opioid Use at County and Managed Care Hospitals
The Journal of the American Osteopathic Association, July 2019, Vol. 119, 419-427. doi:https://doi.org/10.7556/jaoa.2019.078
The Journal of the American Osteopathic Association, July 2019, Vol. 119, 419-427. doi:https://doi.org/10.7556/jaoa.2019.078
Abstract

Context: Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain.

Objective: To investigate whether surgical intervention reduces opioid requirements by patients taking opioids for back pain and whether there is a difference between county and managed care hospitals in this postoperative reduction of opioid requirement.

Methods: A retrospective medical record review of 118 patients who underwent elective lumbar fusion at 4 hospitals (2 county hospitals and 2 managed care hospitals) was conducted. Opioid requirements before and after surgical intervention and at the 30-day outpatient follow-up were evaluated.

Results: Forty medical records were included in the study. An overall decrease in opioid use was found in the postoperative follow-up phase after lumbar fusion in both the county and managed care hospitals. This reduction was statistically significant at 3 of 4 hospitals (P<0.01). When the data were pooled by facility type, the significance remained for county facilities (P<.01) but not managed care facilities (P=.18). Moreover, there was a significant decrease in opioid use during the postoperative inpatient phase for county compared with managed care facilities (P=.0427). The pain rating reported by patients during the hospital stay was significantly higher at county compared with managed care hospitals (P=.0088); however, the difference at discharge was not significant (P=.14).

Conclusion: Our study indicates that lumbar fusion is associated with a significant decrease in opioid use (P<.05) compared with nonsurgical management. Overall, the difference in decreased opioid use between county and managed care hospitals after lumbar fusion was not significant.

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