The effect of a multifaceted intervention on post-operative opioid use after orthopedic and spine surgery: Results of a before-after pilot study.

OBJECTIVE

To assess the clinical effectiveness of a pilot multifaceted intervention to prevent persistent opioid use among patients undergoing orthopedic and spine surgery.

DESIGN

Pre-post pilot study.

SETTING

Two hospitals (academic medical center and affiliated community hospital) in a single healthcare system. Preintervention period was July 1, 2021 to June 1, 2022; post-intervention period was June 2, 2022 to February 28, 2023.

PATIENTS: A total of 171 inpatient orthopedic and neurosurgical spine patients.

INTERVENTION: Multifaceted persistent Opioid use Prevention Program (MOPP), including standardized order sets, pharmacist-led discharge counseling, a virtual post-discharge visit, and a mobile app for tracking pain, function, and opioid use for up to 180 days after hospital discharge.

MAIN OUTCOME MEASURES: Persistent opioid use within 180 days post-discharge.

RESULTS

Outcome assessors were blinded. Of 115 patients in the intervention group, 91 (79 percent) received at least one component of MOPP. Persistent opioid use was observed in 10.9 percent of usual care patients and 4.5 percent in intervention patients (weighted difference -6.4 percent, 95 percent confidence interval [CI] -21 percent, +8.2, p = 0.37). In subgroup analyses, the intervention demonstrated a significant reduction in persistent opioid use among nonopioid-naive patients (weighted difference -40 percent, 95 percent CI -76 percent, -4.2 percent), with evidence of effect modification by opioid-naive status (p value for interaction term 0.005).

CONCLUSIONS

This pilot study demonstrated a nonsignificant overall effect on the primary outcome, with significant effects on nonopioid-naive patients. Further research with a larger trial is needed to validate these findings.