NSAID Use Is Associated With Increased Postoperative Complications, but Mortality Benefit, Following Spinal Fusion

Retrospective cohort study, level III evidence.

This study aimed to evaluate the relationship between anti-inflammatory use and mortality and complications, including pseudoarthrosis, in patients undergoing spinal fusion.

Postoperative pain control after spine surgery frequently requires large doses of narcotics. Opioid complications adversely affect patient outcomes and increase health care costs. In orthopedics, alternative methods of analgesia, including nonsteroidal anti-inflammatory drugs (NSAIDs), have gained momentum with the hope of minimizing postoperative opioids. There remains conflicting and limited evidence regarding the effect of NSAIDs on fusion within the perioperative period, and whether other factors, such as NSAID choice or timing of administration, have an effect.

Data from the Centers of Medicare and Medicaid Services were used to identify patients aged 65 years or older who underwent spinal fusion surgery between 2016 and 2021 and were eligible for Part D (pharmacy) benefits. Patients were divided into 2 cohorts: no NSAIDs (n=169,712) and NSAIDs (n=130,029), based on a Part D claim indicating filling of a prescription within 90 days before the surgical date through 1 year postfusion surgery. Logistic regression was used to compare mortality, pseudoarthrosis, complications, and readmission at 1-year.

The NSAID user cohort was younger with lower Hierarchical Conditions Classification Count scores. Compared with patients treated without NSAIDs, NSAID use in the perioperative period was associated with a statistically significant reduction in 1-year mortality, and significantly greater rates of 1-year readmissions, pseudoarthrosis, and overall complications.

Our observations found that NSAIDs are associated with higher overall complication rates. Further analysis regarding NSAID use in spinal fusion surgery is warranted to understand their full effects.