Rancu Albert L, Gouzoulis Michael J, Winter Adam D, Katsnelson Beatrice M, Ansah-Twum Jeremy K, Grauer Jonathan N
From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg. 2024 Dec 19. doi: 10.5435/JAAOS-D-24-00908.
Lumbar diskectomy is a common procedure, following which a brief course of narcotics is often prescribed. Nonetheless, increasing attention has been given to such prescribing patterns to limit adverse effects and the potential for abuse. This study investigated prescribing patterns of opioid within 90 days following lumbar diskectomy.
Patients undergoing single-level lumbar laminotomy/diskectomy from 2011 to 2021 were identified in the PearlDiver Mariner161 database. Exclusion criteria included the following: additional same-day spine procedures, age less than 18 years, same-day diagnosis of neoplasm, trauma, or infection, prior diagnosis of chronic pain, records active for less than 90 days following surgery, and filled opioid prescription between 7 and 30 days before the surgery. Predictors associated with receiving opioid prescriptions and excess prescribed morphine milligram equivalents (MMEs) were assessed with multivariable regression analyses. Prescribing patterns over the years were then analyzed with simple linear regression and compared for 2011 and 2021.
A total of 271,631 patients met the inclusion criteria. Opioids were prescribed for 195,835 (72.1%) and were independently associated with lower age, female sex, higher Elixhauser Comorbidity Index, and geographic region (P < 0.0001 for each). Greater MMEs were independently prescribed to those who were younger, had higher Elixhauser Comorbidity Index, and lived in specific geographic regions (P < 0.0001 for each). The proportion of patients receiving opioid prescriptions slightly increased over time (69.0% in 2011 to 71.0% in 2021), whereas a decrease was observed in median MMEs prescribed (428.9 in 2011 to 225.0 in 2021, P < 0.0001) and mean number of prescriptions filled (3.3 in 2011 and 2.3 in 2021, P < 0.0001).
Following lumbar diskectomy, this study found clinical and nonclinical factors to be associated with prescribing opioids and prescribed MME. The decreased MME prescribed over the years was encouraging and the decreased number of prescriptions filled suggests that patients are not needing to return for more prescriptions than prior.
腰椎间盘切除术是一种常见手术，术后通常会开具一个短期的麻醉药品处方。尽管如此，人们越来越关注此类处方模式，以限制不良反应和滥用的可能性。本研究调查了腰椎间盘切除术后90天内阿片类药物的处方模式。
在PearlDiver Mariner161数据库中识别出2011年至2021年接受单节段腰椎板切开术/椎间盘切除术的患者。排除标准包括：同日进行的其他脊柱手术、年龄小于18岁、同日诊断为肿瘤、创伤或感染、既往诊断为慢性疼痛、术后记录活跃时间少于90天以及在手术前7至30天开具阿片类药物处方。通过多变量回归分析评估与接受阿片类药物处方和过量开具的吗啡毫克当量（MME）相关的预测因素。然后用简单线性回归分析多年来的处方模式，并对2011年和2021年进行比较。
共有271,631名患者符合纳入标准。195,835名（72.1%）患者开具了阿片类药物，且与年龄较小、女性、较高的埃利克斯豪泽合并症指数和地理区域独立相关（每项P<0.0001）。年龄较小、埃利克斯豪泽合并症指数较高且居住在特定地理区域的患者独立开具的MME更多（每项P<0.0001）。接受阿片类药物处方的患者比例随时间略有增加（2011年为69.0%，2021年为71.0%），而开具的MME中位数有所下降（2011年为428.9，2021年为225.0，P<0.0001），且平均处方填充数量也下降（2011年为3.3，2021年为2.3，P<0.0001）。
本研究发现，腰椎间盘切除术后，临床和非临床因素与阿片类药物处方及开具的MME相关。多年来开具的MME减少令人鼓舞，且处方填充数量减少表明患者无需比以前更多次地返回开具处方。
