Pre-Operative Opioid Prescribing Increases the Risk of Chronic Opioid Use After Lumbar Decompression Surgery

Study DesignRetrospective cohort study.ObjectiveTo analyse the effects of pre-operative opioid prescribing on chronic opioid use following 1-2 level lumbar decompression and the impact on patient reported outcomes.MethodsConsecutive, prospective enrolment of patients who underwent 1-2 level lumbar decompression performed by a single surgeon between October 2020 and February 2024, with minimum 6-month follow-up for degenerative pathologies. Comparison of opioid-naïve and opioid-sensitised patients and regression analyses were performed to determine predictive factors for postoperative opioid use.ResultsOf 254 patients, 77 were opioid-sensitised and 177 opioid-naïve. Opioid-sensitised patients had 3-times higher 6-month post-operative MME (1931 vs 641 mg, P < 0.001) and correlated with MME prescribed 1-month (r = 0.428, P < 0.001) and 3-month pre-operatively (r = 0.594, P < 0.001). More opioid-sensitised patients required opioids at 6-week (36.4% vs 11.3%, P < 0.001), 6-month (31.5% vs 8.5%, P < 0.001) and 12-month (33.8% vs 13.6%, P < 0.001) post-operatively. Opioid use 3-6 months pre-operatively increased the risk for post-operative opioid use at 6-week (OR = 13.4 [95%CI 5.1-35.3], P < 0.001), 6-month (OR = 17.5 [95%CI 6.2-49.7], P < 0.001) and 12-month (OR = 27.4 [95%CI 8.8-85.7], P < 0.001). Opioid-sensitised patients had poorer pre-operative ODI (50.1 vs 39.8, P < 0.001) and EQ-5D-3 L index score (0.48 vs 0.57, P = 0.002). Post-operatively, 6-week, 6-month and 12-month PROMs were similar.ConclusionsPre-operative opioid prescribing predisposes lumbar decompression patients to increased post-operative opioid requirements and higher rates of continued use, particularly when prescribed for >3-month pre-operatively. Post-operative PROMs were similar despite increased post-operative MME requirements. Minimising pre-operative opioid use and/or timely referral can help minimise long-term opioid use.