Abstract
INTRODUCTION: This study aimed to compare the outcomes in patients who received non-steroidal anti-inflammatory drugs (NSAIDs) ≤90 days or 90 days-1 year after posterior cervical fusion (PCF) with those in patients who did not receive NSAIDs after surgery. METHODS: Using the MarketScan(Ⓡ) Research Databases, we analyzed adults (18-90 years) who underwent PCF and adjusted for confounders with inverse probability of treatment weighting (IPTW) to compare outcomes in those receiving NSAIDs ≤90 days or 90 days-1 year after surgery and those not receiving NSAIDs within a year. In one analysis, we included single- and multi-level PCF, and in a sub-group analysis, we focused on single-level PCF. Outcomes included 30-day readmissions, pseudoarthrosis, hardware failure, and wound complications. RESULTS: After IPTW, NSAID use ≤90 days of single- and multi-level PCF was not associated with increased readmissions, pseudoarthrosis, or wound complications. However, NSAID use 90 days-1 year increased the odds of pseudoarthrosis and hardware failure (odds ratio 1.157, 95% confidence interval 1.075-1.245, p<0.001). In single-level PCF, NSAIDs use ≤90 days or 90 days-1 year of surgery was not associated with increased odds of complications. No difference was observed in postoperative complications between patients who took COX-2 selective inhibitors and those who took non-selective NSAIDs. CONCLUSIONS: NSAID use ≤90 days of surgery does not increase the risk of adverse outcomes for either single- or multi-level PCF, suggesting it may be a viable option for pain management. Postoperative NSAID use 90 days-1 year does not seem to increase complications in single-level PCF. However, caution is advised for multi-level fusions or cases with complex clinical factors, in which NSAID use from 90 days-1-year postoperatively may increase the risk of pseudoarthrosis and hardware failure.