Revision Lumbar Fusion Patients Exhibit Higher Long-Term Opioid and Gabapentinoid Needs Despite Similar Early Postoperative Use.

Abstract

Retrospective Cohort. 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. Preoperative opioid exposure and revision surgery are recognized risk factors for prolonged postoperative opioid use after lumbar fusion, yet long-term data remain limited. 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. 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. 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.