Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Hai Le; Eileen Phan; Lauren Agatstein; Joshua Barber; Eric Klineberg; Rolando Roberto; Yashar Javidan

doi:10.1177/2192568220950678

Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Global Spine J. 2022 Mar;12(2):263-266. doi: 10.1177/2192568220950678. Epub 2020 Aug 28.

Authors

Hai Le¹, Eileen Phan¹, Lauren Agatstein¹, Joshua Barber¹, Eric Klineberg¹, Rolando Roberto¹, Yashar Javidan¹

Affiliation

¹ 8789University of California, Sacramento, CA, USA.

Abstract

Study design: Retrospective case series.

Objectives: To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy.

Methods: We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone).

Results: Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed.

Conclusions: We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

Keywords: equivalent; lumbar microdiscectomy; morphine milligram; opioid epidemic; opioid prescription; pain management; prescriptive; spine surgery; variability.