Impact of Body Mass Index on Opioid Prescriptions After Lumbar Spine Surgery

Objective: This study aimed to evaluate the association between body mass index and postoperative opioid use within 2 yrs after lumbar spine surgery using a national database. Methods: TriNetX, a national network of deidentified patient records, was retrospectively queried from 2003 to 2021 using International Classification of Disease 10, Current Procedural Terminology, and Veterans Affairs codes. Propensity score matching analysis was performed based on demographics, comorbidities, anxiety disorders, and mood disorders. Results: A total of 21,997 patients were included in our analysis. Patients with body mass index >= 30 were more likely to be prescribed opioids postoperatively (odds ratio: 1.30; 95% confidence interval: 1.18-1.42). Patients with body mass index >= 40 were more likely to be prescribed opioids when compared to patients with body mass index < 30 (odds ratio: 1.94; 95% confidence interval: 1.48-2.56), body mass index 30-34.9 (odds ratio: 2.06; 95% confidence interval: 1.57-2.70), body mass index 35-39.9 (odds ratio: 1.50; 95% confidence interval: 1.13-2.00), and body mass index < 40 (odds ratio: 2.06; 95% confidence interval: 1.57-2.70). The body mass index >= 40 group had an increased number of opioid prescriptions within 2 yrs after lumbar surgery compared to patients with body mass index 30-34.9 (P = 0.0113) and body mass index < 30 (P = 0.0018). Conclusions: Opioid prescription after lumbar spine surgery is associated with an elevated body mass index. Patients with class III obesity seem to be at the highest risk of increased opioid prescriptions after lumbar surgery. Physicians should consider the patient's body mass index when deciding postoperative pain management.