Hello, I'm Daniel Cummins from the UCSF School of Medicine, and today I'll be talking about our project Opioid Use and Discrepancies in the Electronical Medical Record in Patients Undergoing Elective Spine Surgery. This project was done under the mentorship of Sigrid Berven from the UCSF Department of Orthopedic Surgery. We have no conflicts of interest to disclose. Here's some background on this topic. In a randomized sample of adult patients being treated for opioid dependence, 42% qualified as having chronic pain. In many of these patients, 48.2% had chronic pain reported predominantly from the spine. Increased preoperative opioid use has also been associated with increased length of stay, long-term opioid dependence, and worse functional outcomes following surgery. Notably, the CDC marks morphine milligram equivalents of greater than 50 and greater than 90 as moderate and high-risk use, respectively. Clinical studies on opioid use in spine surgery historically have relied on insurance claims data or self-reported consumption. Therefore, there remains a need to quantify accurate opioid use in the population receiving elective spine surgery. For methods, patient population were those undergoing elective spine surgery for a structural disease at UCSF on opioids for greater than or equal to two months prior to surgery. These patients underwent surgery between the months of May and August of 2020. Exclusion criteria were operations for tumor, abscess or infection, and urgent or emergent cases. In addition to the electronic medical record, our data source also included data from the Controlled Substance Utilization Review and Evaluation System, or CURES, which is California's mandated prescription drug monitoring program. This was compared to data from the electronic medical record, from which preoperative spine clinic note and preoperative anesthesia note data were recorded. Opioid use was quantified using morphine milligram equivalents, or MMEs. These were recorded directly for daily usage from the electronic medical record, while from CURES, this was calculated for dose per day, from the dose dispensed over the prescription interval from the second to last prescription before surgery, to the last prescription before surgery, and converted using a conversion factor for each opioid. For results, there were 440 patients included who had elective spine surgery for a structural disease between May and August of 2020. 236 of these patients, or 53.64%, had a preoperative opioid prescription. Ninety-nine of these patients had data from CURES and EMR that were able to be collected and quantified for comparison. The electronic medical record showed that morphine milligram equivalents of opioid use was inaccurate for 57.2% of patients compared with CURES, and was underestimated for 25.3% of patients. The leftmost screen demonstrates that there was a strong internal correlation in the EMR for opioid use preoperatively, looking at the spine clinic note and the anesthesia prepare note, for which there was an R-squared of 0.89. The middle screen and rightmost screen demonstrates that there was a weak correlation between elements of the EMR and morphine milligram equivalent quantified in CURES, with an R-squared of 0.01 for both elements of the EMR compared with CURES. CURES data showed that 31.3% of patients had daily opioid use greater than 50 mMe, and 17.2% of patients greater than 90 mMe. For results, furthermore, patients taking two opioid medications were significantly more likely than those taking one opioid medication to use greater than 50 mMe per day, 91.7% using two versus 28.4% using one opioid, as well as greater than 90 mMe. For those taking two opioids, 58.3% were greater than 90 mMe versus for those taking one, 14.9%. Both of these results were significant. Age, gender, number of comorbidities, and BMI were not associated with daily opioid use greater than 50 or greater than 90 mMe. For conclusions, in this single-center review of patients undergoing elective spine surgery, preoperative opioid use in the EMR was inaccurate for over 50% of patients. Additionally, 31.3% of patients were found to have daily preoperative opioid use greater than 50 mMe, which indicates moderate risk, and 17.2% greater than 90 mMe, or high risk. Use of greater than one opioid medication may serve to screen for moderate to high risk preoperative opioid use in those undergoing elective spinal surgery. Here are our references, and thank you for listening to this presentation.

UCSF School of Medicine

opioid use

elective spine surgery

electronic medical record

CURES data