Spine - 2026-03-02 - Journal Article
Revision Lumbar Fusion Patients Exhibit Higher Long-Term Opioid and Gabapentinoid Needs Despite Similar Early Postoperative Use.
Olson J, Green WA, Dalton J, Ng M, Baidya J, Huang R, Oris RJ, Herczeg C, Sherman M, Eichbaum Y, Baek G, Mathew J, Lee Y, Hitchner M, Duggan S, DeMario N, Goldberg M, Kaffenes A, Cha T, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD
Topics
Key Takeaway
Revision lumbar fusion patients carry 3x higher opioid burden at 2 years postoperatively (1,550 vs. 497 MME, P<0.001) despite similar 30-day use, with revision status independently predicting greater MME consumption beginning at 1 year (β=964.4).
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Summary
This study compared opioid and gabapentinoid consumption between primary and revision 1–3 level lumbar fusion patients using state PDMP data at 30 days, 90 days, 1 year, and 2 years. Revision patients had 2.9x higher preoperative MME burden (953 vs. 334) and, despite equivalent 30-day postoperative use, demonstrated significantly higher opioid consumption at every subsequent timepoint. Multivariable regression identified preoperative MME as the strongest predictor of long-term use, with revision status independently associated with higher MME at 1 year (β=348.3) and 2 years (β=964.4), and gabapentinoid use elevated in revision patients from 90 days onward (19.3% vs. 13.4%).
Key Limitation
The retrospective design cannot establish whether elevated long-term opioid use reflects persistent neuropathic pain from index pathology, inadequate surgical correction, or pre-existing opioid use disorder behavior, limiting causal inference.
Original Abstract
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.