Opioid Use Disorder Among Cervical Fusion Inpatients: Trends, Complications, and Resource Use in a Retrospective National Inpatient Sample Analysis, 2016-2022

Study designRetrospective cohort study.ObjectivesTo describe temporal trends in opioid use disorder (OUD) among adults undergoing inpatient cervical fusion, identify factors independently associated with OUD, and compare resource use and complications by OUD status.MethodsAdult elective cervical fusion hospitalizations were identified in the National Inpatient Sample (NIS) from 2016 to 2022. OUD was defined using ICD-10-CM code lists. Survey-weighted procedures estimated annual prevalence and group means. Multivariable logistic regression was used to evaluate risk factors associated with OUD as well as medical complications and discharge disposition. Significance was set at <i>P</i> < 0.05.ResultsOdds of OUD were higher at ages 30-39 (OR 2.38, <i>P</i> < 0.001), 40-49 (OR 2.25, <i>P</i> < 0.001), 50-59 (OR 2.11, <i>P</i> = 0.001), and 60-69 (OR 1.65, <i>P</i> = 0.031) vs <30, and increased with clinical severity (Severity 2 OR 1.29; Severity 3 OR 1.79; Severity 4 OR 1.58; <i>P</i> < 0.001 for all). OUD patients had higher odds of undergoing multilevel fusion (OR 1.12, <i>P</i> < 0.001) and having co-occurring mental illness (OR 1.23, <i>P</i> < 0.001), alcohol abuse (OR 1.41, <i>P</i> < 0.001), and cannabis use (OR 1.59, <i>P</i> < 0.001). OUD was associated with higher odds of cardiovascular (OR 1.31, <i>P</i> < 0.001) and mechanical complications (OR 1.76, <i>P</i> < 0.001). OUD was associated with longer inpatient stays (3.23 vs 2.47 days, <i>P</i> < 0.001) and higher costs ($31,900 vs $27,000, <i>P</i> < 0.001) than those without OUD.ConclusionsPatients with OUD undergoing cervical fusion are a clinically complex, resource-intensive subgroup with higher risks of cardiovascular and mechanical complications and non-routine discharge. Targeted risk stratification and OUD-tailored perioperative pathways can be used to improve outcomes.