Association of Opioid Use Disorder on Postoperative Outcomes Following Lumbar Laminectomy: A Nationwide Retrospective Analysis of the Medicare Population

Abstract

Background: Research focused on the association of opioid use disorder (OUD) on postoperative outcomes in patients undergoing primary lumbar laminectomy is lacking. This study aims to observe the impact of OUD on (1) hospital length of stay (LOS), (2) readmission rates, (3) medical complications, and (4) health care expenditures.Methods: A retrospective query was performed using a nationwide claims database from January 2005 to March 2014 for all patients who underwent lumbar laminectomy, yielding a total of 131,635 patients. The study cohort included 3515 patients with OUD, while 128,120 patients served as the comparison cohort. Multivariate binomial logistic regression analyses were used to determine the association of OUD on readmission rates and medical complications, whereas Welch's t tests were used to compare LOS and health care expenditures. A P value less than 0.001 was considered statistically significant.Results: Patients with OUD undergoing lumbar laminectomy had significantly longer hospital LOS (3.68 vs 1.13 days, P < 0.0001). Readmission rates were significantly higher (14.57% vs 7.39%, OR: 1.73, P < 0.0001) in patients who had an OUD. The study cohort was found to have higher incidence and odds (32.36% vs 9.76%, OR: 3.53, P < 0.0001) of 90-day medical complications and total global 90-day episode of care reimbursement rates ($13,635.81 vs $8131.20, P < 0.0001) compared with their counterparts.Conclusions: This study demonstrates OUD to be associated with longer hospital LOS, increased rates of 90-day readmissions, medical complications, and health care expenditures following lumbar laminectomy.Level of Evidence: 3. Clinical Relevance: Results indicate that OUD is associated with worse outcomes following lumbar laminectomy.