Impact of Preoperative Chronic Opioid Use on Postoperative Outcomes Following Lumbar Fusion: A Nationwide Analysis
Global Spine Journal · 16 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Chronic preoperative opioid use is a common, modifiable risk factor before spine fusion, and this study suggests its clearest consequence is ongoing opioid reliance, while its link to surgical complications may be partly explained by mental health and comorbidity.
The evidence
This retrospective cohort study used the national All of Us research database to compare 839 adults who were chronic opioid users before lumbar fusion with 2585 non-chronic users. After propensity-score adjustment, chronic users had about five times the odds of still filling opioid prescriptions 90 to 180 days after surgery (adjusted OR 5.40, 95% CI 4.52 to 6.46; 60.8% vs 18.5%). The higher crude rates of reoperation, readmission, complications, wound problems, pseudarthrosis and death shrank after adjustment and were no longer statistically significant, although the confidence intervals were wide.
Persistent postoperative opioid use (any opioid prescription 90-180 days after surgery): Odds ratio 5.4 (95% CI 4.52 to 6.46; ratio). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Registry cohort (adjusted)Design starting point: 37.4
Raised the score
- Post-adjustment balance demonstrated+4.3
- Aligned time zero+2.5
Lowered the score
- Underpowered−8.5
- Only 1 months of follow-up−6.8
Methods at a glance
Recorded assessment- Confounding adjustmentInverse-probability weighting / doubly robust
- Covariate balance confirmedMet
- Outcome assessors blindedNot reported
- Comparable start of follow-upMet
- Adequate statistical powerUnderpowered
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 37.4
- Post-adjustment balance demonstrated
- +4.3
- Aligned time zero
- +2.5
- Only 1 months of follow-up
- −6.8
- Underpowered
- −8.5
- Journal prior (not an observed method)
- +0.8
- Final rigour score rounded
- 30 / 100
Study design sets the starting point and a ceiling of 80. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that chronic preoperative opioid users had about five-fold higher odds of persistent use after fusion, should a preoperative taper or a structured perioperative opioid-sparing pathway be required before elective lumbar fusion in these patients?
2.When counselling a chronic opioid user about lumbar fusion, how should a surgeon frame the risk of wound complications and nonunion if those risks may reflect the accompanying depression, anxiety and comorbidity rather than the opioids themselves?
Original publication title
Impact of Preoperative Chronic Opioid Use on Postoperative Outcomes Following Lumbar Fusion: A Nationwide Analysis