Preoperative Opioid Use Disorder Predicts Prolonged Ventilation, Central Line Placement, and Major Anesthesiology Complications After ACDF Surgery: A Big Data Analysis of 180,000 Cases

<b>Background:</b> Opioid use disorder (OUD) has emerged as a growing public health challenge, increasingly affecting surgical populations. While anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with known perioperative risks, the specific impact of preoperative OUD on anesthesia-related complications in ACDF remains poorly studied. <b>Methods:</b> We analyzed adult patients undergoing elective single-level ACDF between 2016 and 2022 using the Nationwide Inpatient Sample (NIS) database. Patients with and without OUD were identified using ICD-10 codes. Propensity score matching was applied to adjust for baseline differences. Primary outcomes included prolonged ventilation, central line placement, and major anesthesiology complications. Secondary outcomes included total charges, length of stay, and number of procedures. A cost-effectiveness analysis of universal preoperative urine drug screening was also performed. <b>Results:</b> Among 178,215 patients undergoing ACDF, 1.5% had documented OUD. Following propensity matching, OUD patients had a significantly increased risk of prolonged ventilation (>24 h and >96 h), central line placement, blood transfusion, feeding tube insertion, and major anesthesiology complications. OUD patients experienced longer hospital stays (7.9 vs. 2.7 days), more procedures (4.2 vs. 3.0), and higher total charges ($139,207 vs. $82,179; all <i>p</i> < 0.01). The estimated excess cost attributable to OUD per surgical patient was $855, compared to a $75 screening cost. <b>Conclusions:</b> Preoperative OUD is associated with significantly increased perioperative risk, ICU-level intervention, and healthcare costs in ACDF patients. These findings support systematic preoperative screening and multidisciplinary management for patients with OUD undergoing spine surgery.