• Glenn A Gonzalez, Katherine Corso, Jingya Miao, Sidharth K Rajappan, Guilherme Porto, Manoranjith Anandan, Matthew O'Leary, John Wainwright, Rupert Smit, Kevin Hines, Daniel Franco, Aria Mahtabfar, Cristian DeSimone, Diego Polanco, Reyan Qasba, Sara Thalheimer, Joshua E Heller, Ashwini Sharan, Jack Jallo, and James Harrop.
• Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA. Electronic address: glennarturo.gonzalezozuna@jefferson.edu.
• World Neurosurg. 2023 Feb 1; 170: e467e490e467-e490.

BackgroundOpioids are commonly prescribed for chronic pain before spinal surgery and research has shown an increased rate of postoperative adverse events in these patients.ObjectiveThis study compared the incidence of 2-year subsequent surgical procedures and postoperative adverse events in patients undergoing lumbar fusion with or without 90-day preoperative opioid use. We hypothesized that patients using preoperative opioids would have a higher incidence of subsequent surgery and adverse outcomes.MethodsA retrospective cohort study was performed using the Optum Pan-Therapeutic Electronic Health Records database including adult patients who had their first lumbar fusion between 2015 and 2018. The daily average preoperative opioid dosage 90 days before fusion was determined as morphine equivalent dose and further categorized into high dose (morphine equivalent dose >100 mg/day) and low dose (1-100 mg/day). Clinical outcomes were compared after adjusting for confounders.ResultsA total of 23,275 patients were included, with 2112 patients (10%) using opioids preoperatively. There was a significantly higher incidence of infection compared with nonusers (12.3% vs. 10.1%; P = 0.01). There was no association between subsequent fusion surgery (7.9% vs. 7.5%; P = 0.52) and subsequent decompression surgery (4.1% vs. 3.6%; P = 0.3) between opioid users and nonusers. Regarding postoperative infection risk, low-dose users showed significantly higher incidence (12.7% vs. 10.1%; P < 0.01), but high-dose users did not show higher incidence than nonusers (7.5% vs. 10.1%; P = 0.23).ConclusionsConsistent with previous studies, opioid use was significantly associated with a higher incidence of 2-year postoperative infection compared with nonuse. Low-dose opioid users had higher postoperative infection rates than did nonusers.Copyright © 2022 Elsevier Inc. All rights reserved.

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