OPIOID INTAKE IN SPINE PATIENTS: A QUALITY IMPROVEMENT PROJECT

Transcription

1 OPIOID INTAKE IN SPINE PATIENTS: A QUALITY IMPROVEMENT PROJECT

2 OPIOID USE CDC drug overdoses were the leading cause of injury death in 2013 (Antman et al., 2016) 52% of overdoses were attributed to prescription medications 71% were linked specifically to opioid overdose (Antman et al., 2016).. SIDE EFFECTS OF NARCOTICS Nausea, vomiting, pruritus, sedation, and respiratory depression in the post-operative environment (Reynolds et al., 2016). SIDE EFFECTS AT LEAST ONE HALF DAY INCREASE IN LOS COST $840 PER PATIENT TO HOSPITAL (ODERDA ET AL, 2002)

3 SPINAL FUSION 19% DECREASE IN HRQOL 15 FOLD INCREASE IN SPINAL FUSION FROM 2002 TO TO 19.9 /100,000 IN MEDICARE POPULATION (Wainwright, Immins, &Middleton, 2016). 51 MILLION SURGERIES PER YEAR OVER 70% POSTOPERATIVE PAIN (Arumugam, 2016). SPINAL PROCEDURES ACCOUNT FOR LARGE MAJROITY MIS TECHNIQUES DECREASE

4 STANDARDIZED PROTOCOL Lack of standardization w/ minimizing opioid consumption No patient outcome data No cost savings

5 OBJECTIVE January 2016, the department of Neurological Surgery at RUSH implemented A protocol to decrease the amount of opioid medications patients receive, while improving quality outcomes and ultimately decrease length of stay Primary Decrease in LOS Secondary Decrease in Postop Delirium, Urinary retention, narcotic use

6 STUDY This study used a cross-sectional pre-post retrospective analysis. One level TLIF The pre-protocol July June Post protocol Jan August 2016 Data was obtained from EPIC. Bivariate and Non-parametric analyses length of stay, pain score total overall opioid equivalent score total direct opioid medication cost, quality outcome metrics.

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8 RESULTS

9 RESULTS The Overall Opioid Equivalent mean was ( ) in the pre-protocol sample and ( ) in the post-protocol sample. The decrease viewed in these two time periods was found to be significant with a p-value of.008. The Total Direct Cost for Opioid Medications mean was $92.48 (+63.10) in the pre-protocol group and (+47.70) in the post protocol group with no significant p-value.

10 CONCLUSIONS Outcome Standardized protocol No Significant Decrease in LOS, pain scores, post op delirium, straight catheter use Significant reduction in overall opioid equivalent score between pre and post protocol periods

11 FURTHER CONSIDERATIONS Use in other departments at Rush University Medical Center More patients

12 REFERENCES Antman, K. H., Berman, H. A., Flotte, T. R., Flier, J., Dimitri, D. M., & Bharel, M. (2016). Developing Core Competencies for the Prevention and Management of Prescription Drug Misuse. Academic medicine, 91(10), Arumugam, S. "Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis." 2016:9(2016):631.Web. Cahill, K. S. (2013). Costs of Minimally Invasive Spine Surgery. Minimally Invasive Spinal Deformity Surgery, doi: / _8 Conditions and Procedures. (2016). Retrieved October 16, 2016, from Eberhart, L., Koch, T., Kranke, P., Rüsch, D., Torossian, A., & Nardi Hiebl, S. (2014). Activity-based cost analysis of opioid-related nausea and vomiting among inpatients. Journal of opioid management, 10(6), Muhly, W. T., Sankar, W. N., Ryan, K., Norton, A., Maxwell, L. G., DiMaggio, T.,... Flynn, J. M. (2016). Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis. Pediatrics, 137(4), e e Oderda, G. M., Evans, R. S., Lloyd, J., Lipman, A., Chen, C., Ashburn, M.,... Samore, M. (2003). Cost of opioid-related adverse drug events in surgical patients. Journal of pain and symptom management, 25(3), O'Lynnger, T M, et al. "Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge." Journal of neurosurgery. Pediatrics 17.1 (2016): Web. Philip, B. K., Reese, P. R., Burch, S. P. (2002). The economic impact of opioids on postoperative pain management. Journal of Clinical Anesthesia, 14(5), Reynolds, R. A. K., Legakis, J. E., Tweedie, J., Chung, Y., Ren, E. J., BeVier, P. A., Thomas, S. T. (2013). Postoperative Pain Management after Spinal Fusion Surgery: An Analysis of the Efficacy of Continuous Infusion of Local Anesthetics. Global Spine Journal, 3(1),