Does postoperative gabapentinoid prescription reduce chronic opioid use following short-segment lumbar instrumentation?

Abstract

The aim of this study was to evaluate the impact of initial postoperative gabapentinoid prescription on chronic postoperative opioid use in patients who underwent short-segment lumbar instrumentation by using a large multicenter electronic health record database. A retrospective cohort study was conducted using the TriNetX research network, encompassing adult patients who underwent short-segment posterior lumbar instrumentation between January 1, 2010, and December 31, 2022. Inclusion criteria were limited to patients with preoperative diagnoses of lumbar spinal stenosis, spondylolisthesis, radiculopathy, or scoliosis. Patients were stratified based on whether they were prescribed a gabapentinoid medication (gabapentin or pregabalin) within 30 days following the index procedure. To reduce confounders, 1:1 propensity score matching was performed based on age, sex, race, comorbidities, and preoperative opioid and gabapentinoid prescriptions. Postoperative opioid prescribing patterns were assessed at 3-6 months, 6-12 months, and 12-24 months postoperatively. Medications were identified via RxNorm codes and classified as codeine-based (oxycodone, hydrocodone, codeine, and tramadol) or noncodeine-based (fentanyl, morphine, and hydromorphone). Agents were further stratified by morphine milligram equivalent (MME) potency: strong (MME > 1), moderate (MME = 1), or weak (MME < 1). Among 27,165 eligible patients (mean age 59.5 ± 13.3 years), 11,528 received a gabapentinoid prescription within 30 days postoperatively, while 15,637 did not. After matching, each group consisted of 1893 patients with comparable baseline characteristics. At 3-6 months postoperatively, gabapentinoid recipients had significantly lower odds of being prescribed codeine-based (OR 0.743), noncodeine-based (OR 0.602), and strong (OR 0.574) opioids. No significant difference was observed for weak opioids. At 6-12 months, this association persisted for codeine-based (OR 0.778), noncodeine-based (OR 0.564), and strong (OR 0.589) opioids. At 12-24 months, the gabapentinoid group continued to demonstrate lower odds of noncodeine-based (OR 0.523) and strong (OR 0.612) opioid prescriptions, although differences in codeine-based, moderate, and weak opioids were not significant. Postoperative gabapentinoid prescription within 30 days of short-segment lumbar instrumentation was associated with significantly lower odds of chronic postoperative opioid use, particularly for strong and noncodeine-based agents. These findings support gabapentinoids as a beneficial adjunct in multimodal postoperative pain management.