1084 Opioid Prescribing Guidelines for Neurosurgical Patients: A Multi-Site Analysis of Guideline Implementation and Monitoring With an Automated Text-messaging Platform

INTRODUCTION: Evidence-based opioid prescribing guidelines have resulted in reductions in postoperative prescription size without offsetting increases in patient-initiated refills. While there is extensive literature detailing postoperative opioid usage and guideline implementation in other specialties, data for neurosurgical patients have been limited to date. METHODS: We conducted a prospective study of postoperative opioid use and patient-reported outcomes for 1,215 elective spine and peripheral nerve neurosurgical cases between December 2018 and March 2022, with the implementation of prescribing guidelines in February 2021 at three hospital sites within an academic health system. Opioid prescribing guideline development was based on patient-reported opioid consumption behaviors monitored using an automated two-way text messaging platform. RESULTS: The aggregate response rate to the automated text-messaging system was 48.2% throughout the study period. Prior opioid use, median household income of patient ZIP code, and operative procedure were identified as significant independent estimators of likelihood to respond to opioid-use questions (p<0.05). There were significant reductions in the mean postsurgical opioid prescription for thoracolumbar laminectomies and fusions (p<0.001) after guideline implementation. There was no difference in mean cumulative postsurgical opioid consumption by operative procedure after guideline implementation. Prior opioid use (OR: 1.91, SD: 0.50, p<0.05) and mean pain score (OR: 1.16, SD: 0.06, p<0.01) were significant predictors of elevated opioid use. Pain scores did not significantly differ at postoperative Month 3 by operative procedure. CONCLUSIONS: Opioid prescribing guideline development for neurosurgical cases that is informed by patient-reported opioid behaviors may reduce opioid volume prescribed by operative procedure and the total volume of unused opioid medication retained by patients.