Abstract
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for postoperative pain management after spinal fusion surgeries, but their potential impact on fusion outcomes and wound healing remains controversial. OBJECTIVE: To use a national database and consistent selection criteria to compare the postoperative outcomes of patients who first received NSAIDs ≤ 72 hours, 72 hours to 90 days, and 90 days to 1 year after posterior lumbar fusion (PLF) surgery, to those who never received NSAIDs within the first year of surgery. METHODS: Using the Merative Marketscan Research Databases, we analyzed PLF patients aged 18 to 90 years who underwent either single- and multilevel fusions. A subanalysis focused specifically on single-level fusions. Using the inverse probability of treatment weighting to adjust for confounders, we compared the outcomes of patients first administered NSAIDs at 3 different postoperative timeframes (≤72 hours, 72 hours to 90 days, and 90 days to 1 year) to patients who did not receive NSAIDs within 1 year of surgery. The outcomes evaluated included 30-day readmissions, length of stay, pseudoarthrosis, hardware failure, and wound complications up to 1 year after surgery. RESULTS: Single- and multilevel PLF patients who received >90-day courses of NSAIDs 72 hours to 1 year postoperatively had greater odds of pseudoarthrosis, with those receiving short, ≤30-day courses of NSAIDs 72 hours to 90 days postoperatively additionally having greater odds of wound complications. Meanwhile, patients who started≤30-day courses of NSAIDs within 72 hours of surgery experienced reduced length of stay and lower rates of wound complications. CONCLUSION: Administration of long courses of NSAIDs >72 hours to 1 year after PLF surgery is associated with higher odds of pseudoarthrosis, while short courses of NSAIDs administered 72 hours to 90 days of surgery are additionally associated with higher odds of wound complications. Conversely, patients who received NSAIDs within 72hours of surgery may experience a slightly reduced length of hospital stay, with short courses of NSAIDs protecting against wound complications. CLINICAL RELEVANCE: This study suggests that the timing and duration of postoperative NSAID use after posterior lumbar fusion can significantly affect outcomes, particularly fusion integrity and wound healing. These findings may help guide pain management protocols to balance effective analgesia with minimizing surgical complications.