152. Pain plan implementation decreases postoperative opioid use, hospital length of stay and clinic resource utilization for patients undergoing elective spine surgery

• Published in: The spine journal 2021-09, Vol.21 (9), p.S76-S76
• Main Authors: Uppal, Harjot, Rozenfeld, Sydney, Hesselbach, Kristin, Ludwig, Trisha, Bice, Miranda, Williams, Seth K.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.180

To reduce opioid use, a pain plan was developed and implemented by two surgeons at our institution for patients undergoing elective spine surgery. The pain plan is built collaboratively between the patient and surgeon and is based on previous opioid experience. The pain plan consists of intraoperative, postoperative, and planned discharge medications for pain management. The purpose of this study was to evaluate the effect of pain plan implementation on opioid use, hospital length of stay (LOS), patient-reported pain scores, and clinic resource utilization. This is a retrospective cohort study conducted at an academic medical center-UW Health, Madison, WI. Adult patients undergoing elective spine surgery over a two-year period (n=704). Outcome measures included inpatient opioid use, outpatient opioid prescription quantities, number and complexity of clinic communication encounters, and patient-reported pain scores. The experimental group (with pain plan) comprised patients over the 1-year period after pain plan implementation, while the control group (without pain plan) comprised patients from the 1-year period before implementation. Patients were prospectively divided into three surgical invasiveness (SI) subgroups (small, medium, and large magnitude surgeries) for analysis. Extensive demographic data was collected to validate group comparisons. Parallel analysis was performed on data collected from a spine surgeon at our institution who did not implement the pain plan to analyze time-dependent effects on opioid prescriptions as a potential confounder. A biostatistician performed all statistical analyses. Overall, there was a statistically significant decrease in hospital LOS (p=0.028), inpatient opioid use (p=0.001), the average number of steps per communication encounter (p=0.010), and a trend towards decreased outpatient opioid prescription quantities (p=0.052). Subgroup analyses illustrated a median inpatient opioid use decrease of 50% for large magnitude surgeries (p