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Research ArticleLumbar Spine

The Effect of State-Level Prescription Opioid Legislation on Patient Outcomes After Lumbar Tubular Microdecompression

Edward C. Beck, Jonathan C. White, Anirudh K. Gowd, Tianyi D. Luo, Carl Edge, Ziyad O. Knio and Tadhg J. O’Gara
International Journal of Spine Surgery August 2022, 16 (4) 720-726; DOI: https://doi.org/10.14444/8310
Edward C. Beck
1 Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
MD, MPH
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Jonathan C. White
1 Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
BS
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Anirudh K. Gowd
1 Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
MD
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Tianyi D. Luo
1 Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
MD
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Carl Edge
2 Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
MD
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Ziyad O. Knio
3 Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
MD
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Tadhg J. O’Gara
1 Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
4 Department of Neurosurgery Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA
MD
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Tables

  • Supplementary Materials
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    Table 1

    Comparison of patient demographics.

    DemographicPre-STOP(n = 86)Post-STOP (n = 61) P
    Age, y, mean ± SD63.9 ± 14.867.1 ± 12.40.078
    Sex, male, n (%)43 (50)29 (47.5)0.769
    Body mass index, mean ± SD31.0 ± 6.329.4 ± 5.30.056
    Diabetes, n (%)21 (24.4)16 (26.2)0.803
    Tobacco use, n (%)12 (13.9)7 (11.5)0.659
    History of preoperative prescription opioid use, n (%)53 (61.6)28 (45.9)0.059
    Number of unilateral laminectomies for bilateral decompression, n (%)45 (52.3)33 (54.1)0.832
    Number of far lateral tubular decompressions, n (%)19 (22.1)12 (19.7)0.723
    Number of unilateral hemilaminectomies, n (%)24 (27.9)22 (36.1)0.293
    • Abbreviation: STOP, Strengthen Opioid Misuse Prevention Act.

    • View popup
    Table 2

    Assessment of preoperative and postoperative functional outcomes.

    Outcome MeasurePre-STOPPost-STOP P
    Preoperative
     VAS back pain6.8 ± 2.95.3 ± 2.90.001
     VAS leg pain7.6 ± 2.27.2 ± 2.80.209
     EQ-5D0.29 ± 0.280.28 ± 0.270.368
     ODI55.6 ± 14.559.1 ± 16.30.94
    Postoperative
     VAS back pain3.3 ± 3.02.6 ± 3.00.082
     VAS leg pain2.4 ± 2.91.2 ± 2.40.003
     EQ5-SD0.71 ± 0.300.75 ± 0.310.368
     ODI28.4 ± 21.621.9 ± 19.70.094
     Satisfied patients, n (%)66 (77.6)53 (86.9)0.156
    • Abbreviations: ODI, Oswestry Disability Index; STOP, Strengthen Opioid Misuse Prevention Act; VAS, visual analog scale.

    • Note: Data presented as mean ± SD unless otherwise indicated.

    • View popup
    Table 3

    MCID threshold scores and achievement rates.

    Achievement, n (%)
    Outcome MeasureThreshold ScorePre-STOPPost-STOP P
    VAS back pain1.856 (72.7)36 (60)0.116
    VAS leg pain1.767 (82.7)51 (85)0.717
    EuroQol-Five Dimensions Index0.256 (72.7)44 (77.2)0.557
    Oswestry Disability Index11.763 (77.8)52 (86.7)0.178
    Achieved ≥1 MCID threshold81 (95.3)61(98.4)0.315
    • Abbreviations: MCID, meaningful clinically important difference; STOP, Strengthen Opioid Misuse Prevention Act; VAS, visual analog scale.

    • View popup
    Table 4

    Postoperative opioid use and pain-related visits.

    Outcome MeasurePre-STOPPost-STOP P
    Postoperative opioids prescribed, MME, mean ± SD442.9 ± 259.7262.4 ± 122.6<0.001
    Pain-related calls to clinic, n (%)32 (37.2)22 (36.1)0.887
    Pain-related emergency department visits, n (%)1 (1.2)4 (6.6)0.075
    Pain-related outside scheduled postoperative visits, n (%)4 (4.7)1 (1.6)0.321
    Refills requested, MME, mean ± SD31.7 ± 24.546.4 ± 38.30.321
    • Abbreviations: MME, morphine milligram equivalent; STOP, Strengthen Opioid Misuse Prevention Act.

    • View popup
    Table 5

    Linear regression analysis results.

    MeasureCoefficientStandard Error P
    Preoperative visual analog scale back pain0.1620.0790.062
    Surgery after Strengthen Opioid Misuse Prevention Act−0.1850.4770.033
    Intercept1.4351.190.022

Supplementary Materials

  • Tables
  • Appendix I

    [8310supp001.docx]

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The Effect of State-Level Prescription Opioid Legislation on Patient Outcomes After Lumbar Tubular Microdecompression
Edward C. Beck, Jonathan C. White, Anirudh K. Gowd, Tianyi D. Luo, Carl Edge, Ziyad O. Knio, Tadhg J. O’Gara
International Journal of Spine Surgery Aug 2022, 16 (4) 720-726; DOI: 10.14444/8310

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The Effect of State-Level Prescription Opioid Legislation on Patient Outcomes After Lumbar Tubular Microdecompression
Edward C. Beck, Jonathan C. White, Anirudh K. Gowd, Tianyi D. Luo, Carl Edge, Ziyad O. Knio, Tadhg J. O’Gara
International Journal of Spine Surgery Aug 2022, 16 (4) 720-726; DOI: 10.14444/8310
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