Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Cohort Definition and Selection Criteria
2.3. Outcome Variables (End Points)
2.4. Statistical Analysis
2.5. Ethical Consideration
3. Results
Results of Propensity Score Weight (PSW)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
HCUP | Healthcare Cost and Utilization Project |
ICD-10 | International Classification of Diseases, 10th Revision |
LF | Lumbar Fusion |
LOS | Length of Stay |
NIS | Nationwide Inpatient Sample |
SPSS | Statistical Package for the Social Sciences |
References
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Category | Variable | Codes |
---|---|---|
Lumbar Fusion Procedures | Lumbar Fusion | 0SG0070, 0SG0071, 0G007J |
0SG00A0, 0SG00AJ, 0SG00J0 | ||
0SG00J1, 0SG00JJ, 0SG00K0 | ||
0SG00K1, 0SG0370, 0SG0371 | ||
0SG037J, 0SG03A0, 0SG03AJ | ||
0SG03J0, 0SG03J1, 0SG03K0 | ||
0SG03K1, 0SG03KJ, 0SG0471 | ||
Comorbidities | Opioid Dependence | F11.2x |
Type 2 Diabetes | E11.x | |
Hypertension | I10 | |
Dyslipidemia | E78.x | |
Sleep Apnea | G47.3x | |
Anemia | D64.x | |
Alcohol Abuse | F10.x | |
Smoking | Z72.0 | |
Chronic Kidney Disease | N18.x | |
COPD | J44.x | |
Complications | Surgical Site Infection | T81.4x |
Urinary Tract Infection | N39.x | |
Respiratory Complications | J96.x, J95.x, J80.x, J15.x, J18.x | |
Dural Tear/CSF Leak/Nerve Root Injury | G96.11, G96.00, G96.02, S34.x | |
Acute Renal Failure | N17.x | |
Embolism (PE, DVT) | I26.x, I82.4x | |
Blood Loss | D62.x | |
Cardiac Complications | I44.x, I20.x, I49.x, I50.x, I51.x, I23.x, R96.x, I21.x, I22.x, I24.x, I46.x, T81.1 | |
Stroke | I63.x, G45.x |
Characteristic | Not Opioid Dependent n = 589,740 | Opioid Dependent n = 7715 | p-Value |
---|---|---|---|
Demographics | |||
Age, mean (SD) | 62.16 (12.09) | 58.23 (11.36) | <0.001 |
Female, n (%) | 331,750 (56.3) | 4450 (57.7) | 0.25 |
Hospital Bed Size, n (%) | |||
Small | 162,105 (27.5) | 1165 (15.1) | <0.001 |
Medium | 149,380 (25.3) | 1645 (21.3) | <0.001 |
Large | 278,255 (47.2) | 4905 (63.6) | <0.001 |
Hospital Location/Teaching, n (%) | |||
Rural | 23,100 (3.9) | 305 (4.0) | <0.001 |
Urban Non-teaching | 133,695 (22.7) | 1220 (15.8) | <0.001 |
Urban Teaching | 432,945 (73.4) | 6190 (80.2) | <0.001 |
Hospital Region, n (%) | |||
Northeast | 95,440 (16.2) | 880 (11.4) | <0.001 |
Midwest | 140,800 (23.9) | 2110 (27.3) | <0.001 |
South | 242,980 (41.2) | 2445 (31.7) | <0.001 |
West | 110,520 (18.7) | 2280 (29.6) | <0.001 |
Race, n (%) | |||
White | 471,060 (79.9) | 6225 (80.7) | 0.008 |
Black | 47,125 (8.0) | 650 (8.4) | 0.008 |
Hispanic | 31,300 (5.3) | 415 (5.4) | 0.008 |
Asian | 7295 (1.2) | 15 (0.2) | 0.008 |
Other | 32,960 (5.6) | 410 (5.3) | 0.008 |
Primary Payer, n (%) | |||
Medicare | 288,315 (48.9) | 3885 (50.4) | <0.001 |
Medicaid | 34,490 (5.8) | 990 (12.8) | <0.001 |
Private | 223,510 (37.9) | 2275 (29.5) | <0.001 |
Other | 43,425 (7.4) | 565 (7.3) | <0.001 |
Comorbidities, n (%) | |||
Type 2 Diabetes | 129,170 (21.9) | 1715 (22.2) | 0.75 |
Hypertension | 314,400 (53.3) | 4045 (52.4) | 0.49 |
Dyslipidemia | 247,720 (42.0) | 3030 (39.3) | 0.02 |
Sleep Apnea | 95,790 (16.2) | 1455 (18.9) | 0.005 |
Chronic Anemia | 27,720 (4.7) | 475 (6.2) | 0.01 |
Alcohol Abuse | 6085 (1.0) | 265 (3.4) | <0.001 |
Smoker | 4220 (0.7) | 60 (0.8) | 0.77 |
Chronic Kidney Disease | 36,770 (6.2) | 595 (7.7) | 0.02 |
COPD | 43,690 (7.4) | 985 (12.8) | <0.001 |
Characteristic | Overall | Not Opioid Dependent n = 7715 | Opioid Dependent n = 7715 | p-Value |
---|---|---|---|---|
Age, mean (SD) | 61.88 (11.83) | 62.11 (12.08) | 61.62 (11.54) | 0.20 |
Female (%) | 55.7 | 56.3 | 55.0 | 0.45 |
DM type 2 (%) | 22.2 | 21.9 | 22.5 | 0.65 |
Hypertension (%) | 53.3 | 53.3 | 53.3 | 0.98 |
Dyslipidemia (%) | 42.7 | 42.0 | 43.5 | 0.33 |
Sleep apnea (%) | 16.2 | 16.3 | 16.2 | 0.92 |
Anemia (%) | 4.6 | 4.7 | 4.4 | 0.66 |
Alcohol abuse (%) | 1.1 | 1.1 | 1.2 | 0.60 |
Smoking (%) | 0.7 | 0.7 | 0.7 | 0.93 |
Renal disease (%) | 6.2 | 6.3 | 6.1 | 0.85 |
Lung disease (%) | 7.8 | 7.5 | 8.1 | 0.40 |
Hospital Size (%) | ||||
Small | 27.2 | 27.3 | 27.0 | 0.88 |
Medium | 24.9 | 25.3 | 24.5 | |
Large | 47.9 | 47.4 | 48.5 | |
Hospital Type (%) | ||||
Rural | 4.3 | 3.9 | 4.7 | 0.71 |
Urban non-teaching | 22.2 | 22.6 | 21.8 | |
Urban teaching | 73.5 | 73.5 | 73.5 | |
Region (%) | ||||
Northeast | 15.8 | 16.1 | 15.4 | 0.62 |
Midwest | 23.0 | 23.9 | 21.9 | |
South | 41.6 | 41.1 | 42.2 | |
West | 19.6 | 18.9 | 20.5 | |
Insurance (%) | ||||
Medicare | 48.2 | 48.9 | 47.4 | 0.73 |
Medicaid | 6.0 | 5.9 | 6.1 | |
Private | 38.2 | 37.8 | 38.6 | |
Other | 7.6 | 7.4 | 7.9 |
Complications | (%) | Effect | Estimate | Lower CI | Upper CI | p-Value |
---|---|---|---|---|---|---|
Urinary Tract Infection | 2.6 | OR | 1.40 | 0.90 | 2.16 | 0.12 |
Stroke | 17.8 | OR | 1.34 | 0.39 | 4.61 | 0.63 |
Surgical Site Infection | 0.2 | OR | 3.94 | 1.26 | 12.2 | <0.005 |
Blood Loss Anemia | 17.8 | OR | 1.79 | 1.53 | 2.11 | <0.005 |
Cardiac Complications | 5.3 | OR | 1.53 | 1.15 | 2.03 | <0.005 |
Acute Renal Failure | 2.8 | OR | 1.39 | 0.94 | 2.05 | 0.09 |
Dural Tear/Nerve Root Injury | 0.9 | OR | 1.99 | 0.98 | 4.04 | 0.054 |
Respiratory Complications | 0.3 | OR | 2.17 | 1.54 | 3.06 | <0.005 |
Hospital Outcomes | ||||||
Prolonged LOS (75th %) ($) | RR | 1.17 | 1.12 | 1.22 | <0.005 | |
Length of stay | RR | 1.20 | 1.15 | 1.26 | <0.005 |
Complications | ES | Estimate | Lower CI | Upper CI | p-Value |
---|---|---|---|---|---|
Stroke | OR | 1.51 | 0.48 | 4.74 | 0.48 |
Blood Loss Anemia | OR | 1.84 | 1.62 | 2.08 | <0.005 |
Cardiac Complications | OR | 1.32 | 1.07 | 1.64 | 0.01 |
Acute Renal Failure | OR | 1.36 | 1.00 | 1.84 | 0.04 |
Dural Tear/Nerve Root Injury | OR | 2.21 | 1.40 | 3.49 | <0.005 |
Respiratory Complications | OR | 2.10 | 1.61 | 2.73 | <0.005 |
Urinary Tract Infection | OR | 1.49 | 1.09 | 2.03 | 0.01 |
Surgical Site Infection | OR | 3.27 | 1.34 | 8.02 | 0.009 |
Hospital Outcomes | |||||
Prolonged LOS (75th %) (USD) | RR | 1.25 | 1.10 | 1.42 | <0.005 |
Length of stay | RR | 1.36 | 1.20 | 1.53 | <0.005 |
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Mahamid, A.; Laver, L.; Alfandari, L.; Jabareen, H.; Martonovich, N.; Keren, A.; Behrbalk, E. Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database. J. Clin. Med. 2025, 14, 3929. https://doi.org/10.3390/jcm14113929
Mahamid A, Laver L, Alfandari L, Jabareen H, Martonovich N, Keren A, Behrbalk E. Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database. Journal of Clinical Medicine. 2025; 14(11):3929. https://doi.org/10.3390/jcm14113929
Chicago/Turabian StyleMahamid, Assil, Lior Laver, Liad Alfandari, Hamza Jabareen, Noa Martonovich, Amit Keren, and Eyal Behrbalk. 2025. "Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database" Journal of Clinical Medicine 14, no. 11: 3929. https://doi.org/10.3390/jcm14113929
APA StyleMahamid, A., Laver, L., Alfandari, L., Jabareen, H., Martonovich, N., Keren, A., & Behrbalk, E. (2025). Opioid Dependence Increases Complications and Costs Following Lumbar Spinal Fusion: Insights from a Nationwide Database. Journal of Clinical Medicine, 14(11), 3929. https://doi.org/10.3390/jcm14113929