The Effects of Early and Delayed NSAID Administration on Posterior Lumbar and Cervical Fusion Outcomes

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for postoperative pain management but raise concerns about wound healing and spinal fusion success. This study utilizes a large national database to examine the impact of NSAID administration at different postoperative intervals on outcomes following posterior lumbar (PLF) and cervical (PCF) fusions, aiming to clarify the associated risks and benefits.

Methods: We analyzed data from the Merative™ MarketScan® Research Databases, including adult patients (18–90 years) undergoing PLF and PCF surgeries. The analysis encompassed both single- and multi-level fusions, with subgroup analyses focusing on single-level fusions. We compared outcomes between patients administered NSAIDs at different postoperative intervals: ≤72 hours, 72 hours–90 days, and 90 days–1 year for PLF; and ≤90 days and 90 days–1 year for PCF. Inverse Probability of Treatment Weighting (IPTW) was employed to adjust for confounders. Primary outcomes included 30-day readmissions, length of stay, pseudoarthrosis, hardware failure, and wound complications.

Results: For PLF patients, short courses of NSAIDs administered within 72 hours of surgery were associated with reduced length of hospital stay and lower odds of wound complications, whereas long courses of NSAIDs given 72 hours–1 year postoperatively were linked to increased odds of pseudoarthrosis. In the PCF cohort, early NSAID use (within 90 days) did not increase the risk of complications for single- or multi-level fusions. However, NSAID administration from 90 days–1 year postoperatively elevated the risk of pseudoarthrosis and hardware failure, particularly in multi-level fusions.

Conclusion : Our findings highlight nuanced effects of NSAID administration on spinal fusion outcomes. Early postoperative NSAID use may reduce hospital stay and wound complications in PLF without increasing risks in PCF. Conversely, delayed NSAID administration, particularly long courses beyond 90 days postoperatively, is associated with elevated risks of pseudoarthrosis and hardware failure, warranting caution in complex or multi-level fusion cases. These insights inform the judicious use of NSAIDs for postoperative pain management in spine surgery.