Parker J, Brennan JC, Johnson AH, Peterman MA, Turcotte JJ, Patton CM. Evaluation of an opioid-sparing protocol for spine surgeries performed in an ambulatory surgery center. World J Orthop 2026; 17(8): 122060 [DOI: 10.5312/wjo.122060]
Corresponding Author of This Article
Justin J Turcotte, PhD, Director, Luminis Health Orthopedics, Anne Arundel Medical Center, 2000 Medical Parkway, Annapolis, MD 21401, United States. jturcotte@luminishealth.org
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Orthopedics
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Parker J, Brennan JC, Johnson AH, Peterman MA, Turcotte JJ, Patton CM. Evaluation of an opioid-sparing protocol for spine surgeries performed in an ambulatory surgery center. World J Orthop 2026; 17(8): 122060 [DOI: 10.5312/wjo.122060]
World J Orthop. Aug 18, 2026; 17(8): 122060 Published online Aug 18, 2026. doi: 10.5312/wjo.122060
Evaluation of an opioid-sparing protocol for spine surgeries performed in an ambulatory surgery center
Jack Parker, Jane C Brennan, Andrea H Johnson, Matthew A Peterman, Justin J Turcotte, Chad M Patton
Jack Parker, Jane C Brennan, Andrea H Johnson, Matthew A Peterman, Justin J Turcotte, Chad M Patton, Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, MD 21401, United States
Author contributions: Parker J, Brennan JC, Johnson AH, Peterman MA, Turcotte JJ, and Patton CM contributed to conceptualization, data curation validation, visualization, writing - original draft, writing - review and editing, formal analysis, investigation, methodology, project administration, resources, software; Turcotte JJ and Patton CM contributed to supervision. All authors have read and approved the final manuscript.
AI contribution statement: No artificial intelligence tools were used in the preparation of this manuscript.
Institutional review board statement: This study was deemed exempt by the Institutional Review Board (WCG IRB) and a waiver of informed consent was granted.
Informed consent statement: A HIPAA waiver of informed consent was granted for this retrospective study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data used to perform this study is available from the authors upon reasonable request.
Corresponding author: Justin J Turcotte, PhD, Director, Luminis Health Orthopedics, Anne Arundel Medical Center, 2000 Medical Parkway, Annapolis, MD 21401, United States. jturcotte@luminishealth.org
Received: April 15, 2026 Revised: June 16, 2026 Accepted: July 14, 2026 Published online: August 18, 2026 Processing time: 128 Days and 13 Hours
Abstract
BACKGROUND
Data on opioid-sparing spine surgery is mostly limited to the hospital setting with a focus on perioperative outcomes. There is even less data available on ideal pain management approaches for spine surgery patients in an ambulatory surgery center (ASC) where same-day discharge is inherently required.
AIM
To evaluate the impact of an opioid-sparing protocol (OSP) on patients undergoing spine surgery at an ASC.
METHODS
A retrospective study of 290 patients undergoing 1-2 level surgeries from 2022-2024 was performed. All procedures were performed by one fellowship trained orthopedic-spine surgeon in a hospital-affiliated ASC. Procedures included anterior cervical discectomy/fusion, lumbar laminectomy/discectomy and posterior lumbar fusion. Patients were classified based on whether they were managed postoperatively as usual care (UC) or using an OSP consisting of oral ketorolac, acetaminophen, ibuprofen, gabapentin, diazepam, and tramadol for breakthrough pain. Differences in patient demographics, comorbidities, surgical details, postoperative pain management, and outcomes between the UC (n = 208) and OSP (n = 82) groups were assessed using univariate statistics.
RESULTS
There were no significant differences in patient demographics, comorbidities, number of operative levels, or rates of anterior cervical discectomy/fusion and lumbar laminectomy/discectomy between groups. Patients in the OSP group had a shorter length of stay, were prescribed opioids less frequently in the recovery room, and were prescribed significantly fewer postoperative morphine-milligram-equivalents at discharge [30.0 (30.0-30.0) vs 140.0 (105.0-210.0); P < 0.001] compared to those in the UC group. There were no statistically significant differences in 30-day postoperative outcomes between groups.
CONCLUSION
The use of an opioid-sparing multimodal analgesia protocol for ambulatory spine surgery patients resulted in significant reductions in postoperative opioid consumption without compromising quality outcomes or increasing postoperative resource utilization. Evaluation of similar protocols is warranted to confirm these findings, which suggest opioid-sparing approaches to ambulatory spine surgery are both safe and effective.
Core Tip: The use of an opioid-sparing multimodal analgesia protocol for ambulatory spine surgery patients resulted in significant reductions in postoperative opioid consumption without compromising quality outcomes or increasing postoperative resource utilization. Patients in the opioid-sparing group had a shorter length of stay, were prescribed opioids less frequently in the recovery room, and were prescribed significantly fewer postoperative morphine-milligram-equivalents at discharge compared to those in the usual care group. Opioid sparing multimodal analgesia protocols appear safe and effective for patients undergoing spine surgery in the ambulatory surgery center setting.
