The objective of this study was to assess the relationship between chronic pre-operative opioids and the outcomes of revision surgery and nonunion after single-level lumbar fusion. Opioids are widely utilized for pain management before spine procedures. Studies have associated opioids with unfavorable postoperative outcomes, and animal models have also linked opioid administration with unstable bone healing.

Single-level lumbar fusion patients were identified. Patients with any fracture history within 1 year before surgery were excluded. A chronic preoperative opioid cohort was defined by opioids prescriptions within 3 months prior and within 4–6 months before surgery. The rates of revision surgery within 6 months and nonunion within 6–24 months after surgery were assessed. Univariate analyses of chronic preoperative opioid prescriptions and various comorbidities for revision and nonunion were conducted followed by multivariate analyses controlling for these factors. Individual analyses were run for each of the 3 single-level lumbar fusion procedures.

A total of 8494 single-level lumbar fusion patients were identified. Of the 3929 (46.3%) patients filled criteria for the chronic preoperative opioid cohort, while 3250 (38.3%) patients had no opioid prescriptions within 6 months before surgery. The opioid cohort experienced significantly higher rates of both revisions (3.92% vs. 2.71%, P=0.005) and nonunion (3.84% vs. 2.89%, P=0.027) relative to the opioid-naive cohort. In the multivariate analyses, chronic preoperative opioids were identified as an independent risk factor for revision (odds ratio: 1.453, P=0.006).

We report that chronic opioid prescriptions before lumbar fusion may increase the risk of revision. Although these prescriptions were also associated with increased nonunion, the comparisons did not achieve statistical significance in the multivariate model. Chronic preoperative opioid use may be considered a potential risk factor in arthrodesis populations.