Risk Factors for Prolonged Opioid Use in Opioid-Naïve Patients Following Lumbar Spine Surgery: A MSSIC Study

Introduction: Opioid prescriptions following surgical procedures can place patients at increased risk for opioid dependence. In this study, we identified risk factors associated with prolonged opioid usage in opioid-naive patients undergoing lumbar spine surgery at 90-days, 1-year, and 2-years post-operatively.

Methods: A Michigan Spine Surgery Improvement Collaborative (MSSIC) database search was performed for opioid-naive patients undergoing lumbar surgeries between 3/2018-9/2022. A multivariate analysis was conducted to assess the impact of various independent variables on long term opioid use.

Results: 10% of patients at 90 days (n=589/5750), 6.4% of patients at 1-year (n=253/3979) and 6.0% of patients at 2-years (n=174/2921). Opioid use at 90-days was associated with an elevated risk of continued opioid use at 1-year (5.37[3.38-8.53], p=0.000). Patients with failure to achieve MCID at 90-days, one or two years post-operatively were at an increased risk for prolonged opioid use (2.94[2.40-3.61], p=0.000, 2.45[1.78-3.37], p=0.000, 3.10[2.11-4.56], p=0.000, respectively). Previous spine surgery was associated with increased opioid use at 2-years (1.44[1.08-1.93], p=0.013), while a history of depression and symptoms duration greater than 12 months were associated with continued use at 1-year (1.30[1.01-1.68], p=0.042, 2.13[1.04-4.36], p=0.039, respectively).

Conclusion : Continued opioid use at 90-days was amongst the strongest predictor of long-term opioid use after elective lumbar spine surgery. Identifying and addressing risk factors that may contribute to chronic opioid use will aid surgeons in implementing targeted interventions to minimize opioid dependence postoperatively.