NYU Langone Health, New York, NY.
Spine (Phila Pa 1976). 2022 Jan 1;47(1):34-41. doi: 10.1097/BRS.0000000000004138.
Retrospective comparative; LOE-3.
The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results.
Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction.
A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME).
A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986).
A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence: 3.
回顾性比较；LOE-3。
本研究旨在探讨在进行单或双节段腰椎融合术后，实施机构阿片类药物减少处方政策对医院消费者评估医疗保健提供者和系统（HCAHPS）调查结果的影响。
先前的研究表明，高水平的阿片类药物处方可能部分与产生更高的患者满意度有关。
对 2014 年 10 月至 2019 年 10 月在一家机构接受单或双节段 L3-S1 腰椎融合术的患者进行前瞻性收集数据的回顾性分析。纳入分析的患者需有完整的调查信息。排除有创伤、骨折、脊柱畸形、融合超过两个节段、或既往 L3-S1 腰椎融合术病史的患者。根据手术日期与机构阿片类药物减少政策的实施相关，该政策于 2018 年 10 月 1 日开始。为了更好地比较两组，阿片类药物处方被转换为毫克吗啡当量（MME）。
共有 330 名患者符合纳入标准：259 名在协议前，71 名在协议后。包括 256 例单节段融合和 74 例双节段融合。两组患者的人口统计学特征（P>0.05）几乎没有统计学差异，除了看疼痛管理服务的患者人数增加外，从协议前的 36.7%（95）增加到协议后的 59.2%（42）；P<0.001。估计失血量（EBL）从 533±571mL 减少到 346±328mL（P=0.003）。同时行椎板切除术的患者比例从 71.8%下降到 49.3%（P<0.001）。协议前出院时开具的阿片类药物平均处方量为 534±425MME，而在方案启动后为 320±174MME（P<0.001）。协议前疼痛控制满意度为 4.49±0.85，协议后为 4.51±0.82，差异无统计学意义（P=0.986）。
在单或双节段腰椎融合术后出院时开具的阿片类药物减少与 HCAHPS 调查测量的疼痛管理满意度无统计学显著变化相关。
3。
