Opioid Use, Risk Factors, and Outcome in Lumbar Fusion Surgery

OBJECTIVE: Inappropriate opioid use resulted in 68% of all U.S. drug overdoses in 2017-nearly 75% of all opioid deaths-costing $80 billion per year. It is imperative to understand the impact of opioid use on outcome from surgery for lower back pain disorders. METHODS: A retrospective review of lumbar spinal fusion registry data at a single center from 2015-2018 was performed. A novel algorithm was used to extract opioid utilization from the electronic health record. Number of levels fused, fusion type, and minimally invasive surgery status were collected from the registry, as were depres-sion status, European Quality of Life 5 level score, and Oswestry Disability Index at 6 months to 1 year postoperatively. RESULTS: We included 294 patients (mean age 62 years, 48% male). Patients younger than 65 years trended toward more opioid use before surgery and significantly higher opioid use after surgery (P < 0.0001). Depression trended toward increasing opioid use after surgery (P = 0.08). Fusions of 4 or more levels were associated with overall greater opioid use after surgery (P = 0.03). Higher rate of opioid use before and after surgery is associated with worse European Quality of Life 5 level scores after surgery (P = 0.01 and P = 0.04) and worse Oswestry Disability Index scores after surgery (P = 0.006 and P = 0.002). CONCLUSIONS: This registry finds that younger age and lower functional status scores are associated with higher opioid use before surgery. Opioid use before surgery, younger age, and >4 levels of fusion are associated with higher opioid use after surgery. Overall, opioid use is associated with worse functional outcome and may serve as a marker of disease progression.