Impact of Preoperative Chronic Opioid Use on Postoperative Outcomes Following Lumbar Fusion: A Nationwide Analysis

Study DesignRetrospective cohort study.ObjectivesChronic opioid use is common among patients undergoing lumbar fusion, and preoperative use has been linked to worse postoperative outcomes. However, much of this evidence derives from administrative datasets with limited ability to adjust for mental health. We examined associations between chronic preoperative opioid use and a panel of postoperative outcomes, utilizing linked survey data to enhance control of confounding.MethodsRetrospective cohort study within a diverse national research program. Adults undergoing lumbar fusion were classified as chronic opioid users (≥3 opioid prescriptions spanning ≥90 days in the preoperative year) or non-chronic users. Outcomes were persistent postoperative opioid use (prescriptions 90-180 days after surgery), reoperation, readmission, major medical complications, wound complications, pseudarthrosis, and death.ResultsAmong 3424 patients, chronic use was strongly associated with persistent postoperative opioid use ([aOR] 5.40; 95% CI, 4.52-6.46). In contrast, crude associations with surgical outcomes were substantially attenuated after adjustment and were not statistically significant, although confidence intervals for several outcomes did not exclude clinically meaningful effects: reoperation (aOR 0.95; 95% CI, 0.76-1.19), readmission (1.10; 0.92-1.33), major complications (1.03; 0.78-1.34), wound complications (1.36; 0.97-1.88), pseudarthrosis (1.33; 0.86-2.01), and all-cause mortality (1.17; 0.74-1.82).ConclusionChronic preoperative opioid use predicted persistent postoperative use but showed no statistically significant independent association with adverse surgical outcomes after adjustment, though the surgical models were underpowered and though confidence intervals did not exclude clinically meaningful effects for pseudarthrosis and wound complications. The attenuation of crude associations suggests that surgical risks attributed to chronic opioid use may in part reflect confounding by mental health and comorbidity rather than a direct effect.