Article Abstract

Comparison of implant survivability in primary 1- to 2-level lumbar fusion amongst opioid abusers and non-opioid abusers

Authors: Rushabh M. Vakharia, Chester J. Donnally III, Augustus J. Rush III, Ajit M. Vakharia, Derek D. Berglund, Neil V. Shah, Michael Y. Wang


Background: Primary lumbar fusion (LF) is a treatment option for degenerative disc disease. The literature is limited regarding postoperative complications in opioid abusers undergoing LF. The purpose of this study was to compare 2-year short term implant-related complications, infection rates, 90-day readmission rates, in-hospital length of stay, and cost of care amongst opioid abusers (OAS) and non-opioid abusers (NAS) undergoing primary 1- to 2-level primary lumbar fusion (1-2LF).
Methods: A retrospective review was performed using the Medicare Standard Analytical Files from an administrative database. Patients undergoing LF were queried using the International Classification of Disease, ninth revision (ICD-9) procedure codes 81.04–81.08. Patients who underwent 1-2LF were filtered using ICD-9 procedure code 81.62. Inclusion criteria for the study group consisted of patients undergoing primary 1-2LF with a diagnosis of opioid abuse and dependency 90-day prior to the procedure. NAS undergoing 1-2LF served as controls. Patients in the study group were matched to controls according to age, gender, and Charlson-Comorbidity Index (CCI). Two mutually exclusive cohorts were formed and outcome measures analyzed and compared were implant complications, infection rates, 90-day readmission rates, LOS, and cost of care.
Results: After the matching process 13,342 patients were identified with equal cohort distribution. OAS had higher odds implant related complications (OR: 2.78, P<0.001) such as prosthetic joint dislocation (OR: 3.83, P<0.001), requiring revision (OR: 2.89, P<0.001), pseudarthrosis (OR: 2.50, P<0.001), and spine related infections (OR: 1.58, P<0.001) compared to NAS. OAS had higher 90-day readmission rates, (OR: 1.29, P<0.001), higher hospital costs ($143,057.38 vs. $121,450.45, P<0.001), and greater in-hospital LOS (P<0.001).
Conclusions: OAS are susceptible to complications following primary 1-2LF. Appropriate patient counseling regarding the effects of opioids on lumbar fusion should be given priority to maximize patient outcomes. Future studies should investigate the impact of pre-operative opioid abuse versus post-operative opioid use.