The Journal of the American Academy of Orthopaedic Surgeons · 2025
The Effect of Nonsteroidal Anti-Inflammatory Drug Contraindications on Opioid Use, Length of Stay, and Patient-Reported Outcomes After Lumbar Fusion.
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Carter Michael, Narayanan Rajkishen, Toci Gregory, Lee Yunsoo, Opara Olivia, Hassan Waqaas A, Tewell Nick, Toth Allison, Sabitsky Matthew, Fras Sebastian, Bowen Grace, Von Suskil Max, Kurd Mark, Kaye Ian David, Canseco Jose, Hilibrand Alan, Vaccaro Alexander, Kepler Christopher, Schroeder Gregory
Аннотация
OBJECTIVE: To assess opioid use, length of stay (LOS), and patient-reported outcome measures (PROMs) among patients undergoing lumbar fusion with contraindications to nonsteroidal anti-inflammatory drugs (NSAIDs) compared to those without any contraindications.
SUMMARY OF BACKGROUND DATA: Nonsurgical patients with NSAID contraindications have an increased association with opioid use disorder. There is a lack of research examining long-term pain medication trends among surgical patients with NSAID contraindications, specifically before and after lumbar fusion.
METHODS: Patients aged 18 years or older who underwent lumbar fusion from 2018 to 2019 were analyzed and compared based on NSAID contraindication. Opioid utilization (total number of prescriptions and morphine milligram equivalents [MMEs]) and benzodiazepine, muscle relaxant, and pregabalin/gapentin usage were tracked from 1 year preoperatively to 2 years postsurgery, through Pennsylvania Prescription Drug Monitoring Program.
RESULTS: Two hundred sixteen patients had ≥1 NSAID contraindication, whereas 639 did not have any contraindications. LOS was markedly longer by approximately 1 day ( P = 0.004) for NSAID contraindication patients. On bivariate analysis, more patients with NSAID contraindications consumed opioids within 1 year before surgery ( P = 0.008), and these patients consumed a higher MME at 30 to 60 days ( P < 0.001) and 0 to 30 days ( P = 0.034) preoperatively. Postoperatively, patients with NSAID contraindications also consumed higher MMEs from 30 to 90 days ( P = 0.034), 90 to 365 days ( P = 0.003), and 1 to 2 years ( P = 0.001). Patients with NSAID contraindications had higher gabapentin/pregabalin usage. No differences existed regarding ΔPROMs between the cohorts. On multivariate analysis, specific NSAID contraindications (allergy and history of gastric surgery) independently predicted a longer LOS ( P = 0.018 and 0.027, respectively) and greater postoperative opioid prescriptions ( P < 0.001).
CONCLUSION: Patients with contraindications to NSAIDs remained in the hospital longer and consumed higher quantities of opioids. Despite this, patients with NSAID contraindications reported comparable PROMs to patients without contraindications. Providers should strongly consider alternative pain management strategies in this population, and future research should investigate the effect of specific NSAID contraindications in their ability to prolong LOS and increase postoperative opioid use.
STUDY DESIGN: A retrospective cohort study.
SUMMARY OF BACKGROUND DATA: Nonsurgical patients with NSAID contraindications have an increased association with opioid use disorder. There is a lack of research examining long-term pain medication trends among surgical patients with NSAID contraindications, specifically before and after lumbar fusion.
METHODS: Patients aged 18 years or older who underwent lumbar fusion from 2018 to 2019 were analyzed and compared based on NSAID contraindication. Opioid utilization (total number of prescriptions and morphine milligram equivalents [MMEs]) and benzodiazepine, muscle relaxant, and pregabalin/gapentin usage were tracked from 1 year preoperatively to 2 years postsurgery, through Pennsylvania Prescription Drug Monitoring Program.
RESULTS: Two hundred sixteen patients had ≥1 NSAID contraindication, whereas 639 did not have any contraindications. LOS was markedly longer by approximately 1 day ( P = 0.004) for NSAID contraindication patients. On bivariate analysis, more patients with NSAID contraindications consumed opioids within 1 year before surgery ( P = 0.008), and these patients consumed a higher MME at 30 to 60 days ( P < 0.001) and 0 to 30 days ( P = 0.034) preoperatively. Postoperatively, patients with NSAID contraindications also consumed higher MMEs from 30 to 90 days ( P = 0.034), 90 to 365 days ( P = 0.003), and 1 to 2 years ( P = 0.001). Patients with NSAID contraindications had higher gabapentin/pregabalin usage. No differences existed regarding ΔPROMs between the cohorts. On multivariate analysis, specific NSAID contraindications (allergy and history of gastric surgery) independently predicted a longer LOS ( P = 0.018 and 0.027, respectively) and greater postoperative opioid prescriptions ( P < 0.001).
CONCLUSION: Patients with contraindications to NSAIDs remained in the hospital longer and consumed higher quantities of opioids. Despite this, patients with NSAID contraindications reported comparable PROMs to patients without contraindications. Providers should strongly consider alternative pain management strategies in this population, and future research should investigate the effect of specific NSAID contraindications in their ability to prolong LOS and increase postoperative opioid use.
STUDY DESIGN: A retrospective cohort study.