Ghanchi H, Miulli D, Kashyap S, Toor H, Farr S, Ray K, Ashraf N, Rao S, Sweiss R, Beamer Y. Comparison of Lumbar Fusion for Back Pain and Opioid Use at County and Managed Care Hospitals. J Am Osteopath Assoc 2019;119(7):419–427. doi: https://doi.org/10.7556/jaoa.2019.078.
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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.
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.
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.
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).
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.
Abbreviations: MME, morphine milligram equivalent; NA, not applicable.
a Pain was assessed using the Numeric Pain Rating Scale (0 [no pain at all] to 10 [worst imaginable pain]).
Abbreviation: MME, morphine milligram equivalent.
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