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PICTURE: This is the opioid prescription rate for n number of pills written before and after the intervention, all lumbar spine surgery (decompression and fusion), p view more
Credit: © 2018 American Association of Neurological Surgeons.
CHARLOTTESVILLE, VA (FEBRUARY 5, 2019). As we all know, opioid addiction in the United States has reached epidemic proportions. In 2017 alone, opioids were involved in overdose death of 47,600 people. Many victims of opioid abuse began their journey with medications prescribed by a physician that were originally provided for the management of acute or chronic pain. Pain is often caused by lumbar spine injury or a temporary side effect of lumbar spine surgery.
Physicians and medical institutions are actively seeking solutions to reduce the risk of opioid addiction. One of the goals is to reduce the amounts of opioids initially prescribed to patients with acute pain. Excessive opioid treatment can potentially lead to addiction in patients or misuse by family members or other people with access to opioid pills.
In the New York Special Surgical Hospital (HSS) (number 1 in orthopedics 2018-19 by US News & World Report), a working group has developed a one-hour educational program on use and misuse of opiates, the role of prescribing orthopedics, multimodal badgesia and state laws regarding the prescription of opioids. All opioid prescribers in the facility were mandated to attend the program in person or through an online presentation. A committee composed of spinal surgeons, pain management physicians, anesthesiologists and nurse managers set guidelines for prescribing opioids following spinal surgery. These qualitative guidelines, based on opioid consumption by patients during their stay at the hospital, were disseminated throughout the hospital in early 2017.
In the article "An Institutional Intervention to Change Opioid Prescribing Practices After Lumbar Spine Surgery", published today in the Journal of Neurosurgery: Spine, Francis Lovecchio, MD, and colleagues, question whether this intervention – mandatory provider training and prescribing guidelines – could alter the prescriber's behavior, resulting in a reduction in the number of opioids prescribed at the exit of the prescriber. hospital after lumbar surgery.
Lovecchio and colleagues compared the opioid prescription data contained in the electronic medical records of 1,177 patients treated by lumbar surgery before the intervention (from March 1 to November 1, 2016) with similar data in the records electronic medical of 1302 patients treated after the intervention (from 1st to 1st February 2016). October 1, 2017). Since a variety of opioid drugs with different concentrations had been prescribed, the researchers converted the amount of opioid by prescription into an oral morphine equivalent (OME) to allow for comparisons.
The researchers found a statistically significant reduction in the average amount of opioids (629 ± 294 OMEs before the intervention versus 490 ± 245 OMEs after the intervention, p
The researchers estimate that in the 8 months following the release of the guidelines, "the change in prescribing practices may have prevented the delivery of more than 26,000 narcotic tablets".
Lovecchio and colleagues show how the intervention within HSS has altered the behavior of prescribers, which has reduced the amount of prescribed opioids. They suggest that future studies should be undertaken to examine how these behavioral changes in prescribers may affect outcomes for patients.
Asked about the importance of the study, Dr. Lovecchio said: "While we have been able to show that qualitative prescribing recommendations act to change the behavior of prescribers, the most practical way to over prescribe is to define the "minimum amount needed" This will prove difficult because postoperative opioid consumption probably depends on the complex interaction of biological, psychosocial and surgical-related factors, as well as patient expectations. and many others are working towards this end, and I look forward to finding solutions.
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F Lovecchio, JG Stepan, A Premkumar, ME Steinhause, Sava M, Derman P, HJ Kim, Albert T .: An Institutional Intervention to Change Opioid Prescribing Practices After Lumbar Surgery. Spine, published before printing on February 5, 2019. DOI: 10.3171 / 2018.8.SPINE18386.
Disclosure: Dr. Albert has been a consultant for NuVasive, Facet Link, Zimmer Biomet and DePuy Synthes; receives royalties from JP Medical Publishers, Saunders / Mosby-Elsevier, Zimmer Biomet, DePuy Synthes and Thieme; served on the Medical Advisory Board for Gentis and United Health Care; owns United Health Care; directly owns shares in Gentis, Vital 5, Bonovo Orthopedics Inc., Biomerix, InVivo Therapeutics, Spinicity, Crosstrees Medical, Paradigm Spine LLC, Invuity, ASIP, PMIG and Pioneer; is an employee of Weill Cornell Medical College; has received support from PCORI, NIH and ISSG for clinical or research work unrelated to the study; and is president of the Scoliosis Research Society and past president of the Cervical Spine Research Society.
Drs. Lovecchio, Stepan, Premkumar, Steinhaus, Kim, Albert and Mrs. Sava are affiliated with the Hospital of Special Surgeries of New York, NY; Dr. Derman is affiliated with Midwest Orthopedics in Rush, Chicago, IL.
For more information, contact: Ms. Jo Ann M. Eliason, Communications Manager, JNS Publishing Group, One Morton Drive, Suite 200, Charlottesville, VA 22903; Email [email protected]; Phone 434-982-1209.
the Journal of Neurosurgery: Spine is a monthly peer-reviewed journal devoted to neurosurgical approaches to the treatment of diseases and disorders of the spine. It contains various articles, including descriptions of preclinical and clinical research, as well as case reports and technical notes. the Journal of Neurosurgery: Spine is one of four monthly journals published by the JNS Publishing Group, the scholarly journals division of the American Association of Neurological Surgeons. The JNS Publishing Group publishes monthly peer-reviewed journals, including the Journal of Neurosurgery, Neurosurgical Focus, and the Journal of Neurosurgery: Pediatrics. The four journals are available at the following address: http: // www.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational badociation with more than 10,000 members worldwide. AANS is dedicated to advancing the specialty of neurological surgery to provide the highest quality neurosurgical care to the public. All active members of the AANS are accredited by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada (Neurosurgery) or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty that deals with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the brain, spine, spinal cord and peripheral nerves. For more information, visit http: // www.
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