Evaluating Postoperative Outcomes, Costs, Length of Stay, and Complications in Opioid-Dependent Patients: A Comparative Analysis Using the National Inpatient Sample

Introduction: Opioid dependence is prevalent among patients undergoing lumbar spinal fusion and has been linked to poor postoperative outcomes. However, its specific impact on surgical complications and hospital resource utilization remains unclear. This study evaluates the association between opioid dependence and postoperative complications, length of stay (LOS), and hospital charges in lumbar fusion patients. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2021. Adult patients (aged >18 years) who underwent lumbar fusion surgery were identified and categorized based on opioid dependence using ICD-10 codes. Propensity score weighting (PSW) was employed to balance baseline characteristics. Primary outcomes included inpatient mortality, LOS, hospital charges, and postoperative complications. Statistical analyses were performed using survey-weighted generalized linear models. Results: Among 597,455 lumbar fusion patients, 7,715 (1.3%) had documented opioid dependence. After PSW, opioid-dependent patients had significantly increased odds of blood loss anemia (OR 1.79, p < .001), respiratory complications (OR 2.17, p < .001), surgical site infections (OR 3.94, p = .001), and cardiac complications (OR 1.53, p = .002). They also had higher hospital charges (mean difference $17,739.2, p < .001) and prolonged LOS (mean difference 0.83 days, p < .001). Differences in urinary tract infections, acute renal failure, and stroke were not statistically significant after PSW. Conclusion: Opioid dependence is associated with increased postoperative complications, longer hospital stays, and higher healthcare costs in lumbar fusion patients. These findings highlight the need for improved perioperative pain management and opioid stewardship strategies to optimize surgical outcomes.