Preoperative Opioid Use is a Robust Predictor of Increased Health Care Utilization Following Lumbar Spine Surgery

Retrospective cohort study.

The aim of this study was to evaluate the association between preoperative opioid use and postoperative health care utilization following elective lumbar spine surgery, and to characterize differences in surgical indications and procedures between opioid-naive (ON) and opioid-experienced (OE) patients.

The U.S. opioid crisis continues to cause thousands of deaths yearly. Despite fewer prescriptions nationally, opioids remain common for pain control in spine surgery, where over half of the patients use them preoperatively.

Adults who underwent elective lumbar decompression with or without fusion between 2013 and 2018 at a single academic center were retrospectively reviewed. Patients were classified as OE if they had at least one opioid prescription within 60 days preoperatively. Demographics, surgical details, and postoperative health care utilization within 1 year, which included imaging, urgent care visits, physical therapy, pain referrals, and neuromodulator prescriptions, were compared between the OE and ON groups. Unadjusted and adjusted multivariable regression and sensitivity analyses were conducted to assess independent associations.

Among 433 patients, 70.5% were OE and 29.5% were ON. On unadjusted analysis, OE patients had significantly higher rates of neuromodulator prescriptions at 180 days (P<.0001) and total imaging studies at 1 year (P=.0014). After multivariable adjustment, preoperative opioid use remained independently associated with increased neuromodulator prescriptions at 180 days (β=0.23, P=.0069) and higher odds of persistent opioid use at 1 year (OR: 2.35, 95% CI: 1.15-4.83, P=.0196). No significant differences were observed in total imaging, lumbar x-ray imaging, or urgent care utilization after adjustment.

Preoperative opioid use is associated with increased postoperative neuromodulator use and a higher risk of long-term opioid persistence following lumbar spine surgery. These findings highlight the need for targeted perioperative interventions to improve surgical outcomes.