Simple Measures to Reduce Opioid Prescriptions Following Pediatric Spinal Fusion Surgery: A Multidisciplinary Quality Improvement Project

BACKGROUND: The opioid epidemic is one of the biggest challenges facing modern healthcare. Among the adolescent and young adult populations opioid overdose is one of the leading causes of death. LOCAL PROBLEM: Within pediatric orthopaedics, spinal fusion is a common procedure making up 7% of the surgical volume at our institution. Spinal fusion also has high postoperative opioid prescribing rates. Review of baseline data showed that there was wide variability in prescribing habits. The goal of this quality initiative was to reduce and standardize post-operative opioid prescribing following spinal fusion procedures. METHODS: Data, including opiate-prescribing habits and a patient survey to assess patient and parent satisfaction with pain control, was collected retrospectively in the pre-intervention phase for 99 consecutive Adolescent and Juvenile Idiopathic Scoliosis patients undergoing spinal fusion surgery. This was followed with 2 PDSA cycles following implementation of a new protocol during which prospective surveys were administered to a total of 273 patients. Physician prescribing data was collected for 150 patients during the sustain phase. INTERVENTIONS: A multi-pronged approached was utilized consisting of the following aspects: 1) Instruction to orthopaedic trainees to limit opioid prescriptions to 45 and 40 for PDSA cycles 1 and 2, respectively. 2) A pharmacy-led education program with an opioid tapering handout given to families and encouragement of usage of non-opioid pain control. 3) A call to the prescribing physician from pharmacy if the prescribed dosage was greater than the maximum allowed. RESULTS: There was a significant reduction in opioid prescriptions from a preintervention mean of 48.5 doses to a PDSA 1 mean of 39.0, PDSA 2 mean of 37.5, and a sustain phase mean of 36.4 (p=0.000). This represented an estimated reduction of 22.8% over the course of the study. During this time, there was no significant change in patient and parent reported postoperative pain. CONCLUSIONS: Through simple measures, our institution was able to significantly reduce total opioid prescriptions following spinal fusion surgeries while maintaining good pain control.