Prolonged Opioid Use After Lumbar Fusion Surgery: A Meta-Analysis of Prevalence and Risk Factors

Background: Persistent opioid utilization after spine surgery is a rising complication among both preoperatively opioid-naïve and opioid-tolerant patients. To our knowledge, this is the first meta-analysis to determine the prevalence and characterize the risk factors that predispose patients to prolonged opioid use (≥3 months) after lumbar fusion. Methods: Studies were identified through searches in PubMed and EMBASE from each database's earliest records to February 1, 2022. We included observational studies examining the risk factors and rates of prolonged opioid use following lumbar fusion. Pooled odds ratios (ORs) or standardized mean differences with corresponding 95% confidence intervals (CI) were estimated using inverse-variance methods. Results: In this meta-analysis of 12 studies encompassing 80,935 patients, 40.2% of patients continued to fill opioid prescriptions ≥3 months after lumbar fusion. Significant sociodemographic predictors included Medicare or Medicaid insurance (OR=1.60, 95% CI 1.36–1.88), African-American ethnicity (OR=1.29, 95% CI 1.18–1.41), being from the Southern United States (OR=1.18, 95% CI 1.11–1.25), or women (OR=1.10, 95% CI 1.01–1.20). Being from the Midwestern United States (OR=0.80, 95% CI 0.75–0.85) was found to be a protective factor. Comorbidities associated with increased risk of prolonged opioid use were preoperative opioid use (OR=5.76, 95% CI 3.52–9.41), drug abuse (OR=3.11, 95% CI 2.37–4.08), alcohol abuse (OR=2.37, 95% CI 2.14–2.64), psychiatric disorders (OR=2.29, 95% CI 1.94–2.70), smoking history (OR=1.81, 95% CI 1.23–2.66), arthritis (OR=1.35, 95% CI 1.29–1.40), and higher American Society of Anesthesiologists score (standardized mean difference=0.72, 95% CI 0.61–0.82). Conclusions: The high prevalence of prolonged opioid use after lumbar fusion underscores the importance of screening patients for comorbidities and implementing targeted strategies to minimize opioid misuse.