Spine · 2026
Revision Lumbar Fusion Patients Exhibit Higher Long-Term Opioid and Gabapentinoid Needs Despite Similar Early Postoperative Use.
СтатьяНазвание и аннотация: Перевод в очереди
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Olson Jarod, Green William A, Dalton Jonathan, Ng Mitchell, Baidya Joydeep, Huang Rachel, Oris Robert J, Herczeg Chloe, Sherman Matthew, Eichbaum Yasmine, Baek Gregorio, Mathew Joshua, Lee Yulia, Hitchner Morgan, Duggan Samuel, DeMario Nick, Goldberg Marco, Kaffenes Anastasia, Cha Thomas, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher K, Schroeder Gregory D
Аннотация
STUDY DESIGN: Retrospective Cohort.
OBJECTIVE: This study aimed to: (1) compare opioid use between primary and revision fusion patients; (2) evaluate differences in non-opioid analgesic use; and (3) identify risk factors of long-term opioid consumption.
SUMMARY OF BACKGROUND DATA: Preoperative opioid exposure and revision surgery are recognized risk factors for prolonged postoperative opioid use after lumbar fusion, yet long-term data remain limited.
METHODS: Patients who underwent elective 1-3 level lumbar spine fusion between were retrospectively identified and chart reviewed (2018-2023). Opioid and non-opioid prescription data was extracted from the state prescription drug monitoring program (PDMP) at 30 days, 90 days, 1 year, and 2 years. Patients were stratified into primary versus revision fusion cohorts and compared using bivariate and multivariable analyses.
RESULTS: A total of 1,938 patients were analyzed (1,498 primary, 440 revision). Revision patients had greater preoperative opioid morphine milligram equivalent (MME) burden (953 vs. 334, P<0.001). Postoperatively, opioid use rates were similar through 30 days, but revision patients demonstrated higher MME use at 90 days (428 vs. 219, P<0.001), 1 year (1,142 vs. 382, P<0.001), and 2 years (1,550 vs. 497, P<0.001). Gabapentinoid use was also higher in revision patients beginning at 90 days (19.3% vs. 13.4%, P=0.003). Multivariable regression confirmed preoperative MME as the strongest risk factor of long-term opioid burden. Revision status was independently associated with higher MME use at 1 year (β=348.3, P=0.011) and 2 years (β=964.4, P<0.001), but not at 90 days.
CONCLUSIONS: Revision lumbar fusion patients demonstrate a greater pre- and postoperative opioid burden, and a greater postoperative gabapentinoid burden. Multivariable analysis confirms revision status as an independent risk factor of greater long-term MME use, beginning at 1 year. Together these findings suggest a complex, possibly neuropathic pain phenotype in revision patients, underscoring the need for tailored perioperative counseling and consistent long-term, multidisciplinary pain management.
OBJECTIVE: This study aimed to: (1) compare opioid use between primary and revision fusion patients; (2) evaluate differences in non-opioid analgesic use; and (3) identify risk factors of long-term opioid consumption.
SUMMARY OF BACKGROUND DATA: Preoperative opioid exposure and revision surgery are recognized risk factors for prolonged postoperative opioid use after lumbar fusion, yet long-term data remain limited.
METHODS: Patients who underwent elective 1-3 level lumbar spine fusion between were retrospectively identified and chart reviewed (2018-2023). Opioid and non-opioid prescription data was extracted from the state prescription drug monitoring program (PDMP) at 30 days, 90 days, 1 year, and 2 years. Patients were stratified into primary versus revision fusion cohorts and compared using bivariate and multivariable analyses.
RESULTS: A total of 1,938 patients were analyzed (1,498 primary, 440 revision). Revision patients had greater preoperative opioid morphine milligram equivalent (MME) burden (953 vs. 334, P<0.001). Postoperatively, opioid use rates were similar through 30 days, but revision patients demonstrated higher MME use at 90 days (428 vs. 219, P<0.001), 1 year (1,142 vs. 382, P<0.001), and 2 years (1,550 vs. 497, P<0.001). Gabapentinoid use was also higher in revision patients beginning at 90 days (19.3% vs. 13.4%, P=0.003). Multivariable regression confirmed preoperative MME as the strongest risk factor of long-term opioid burden. Revision status was independently associated with higher MME use at 1 year (β=348.3, P=0.011) and 2 years (β=964.4, P<0.001), but not at 90 days.
CONCLUSIONS: Revision lumbar fusion patients demonstrate a greater pre- and postoperative opioid burden, and a greater postoperative gabapentinoid burden. Multivariable analysis confirms revision status as an independent risk factor of greater long-term MME use, beginning at 1 year. Together these findings suggest a complex, possibly neuropathic pain phenotype in revision patients, underscoring the need for tailored perioperative counseling and consistent long-term, multidisciplinary pain management.