Socioeconomic Disparities in Postoperative Opioid Use Following Spine Surgery: A Retrospective Analysis of Area Deprivation Index and Household Income

Introduction: The opioid epidemic has heightened scrutiny of postoperative opioid prescribing, particularly in spine surgery. Socioeconomic factors may influence opioid use patterns, but their impact is not fully understood. The

Purpose: of this study is to investigate the relationship between socioeconomic factors, clinical characteristics, and opioid prescriptions following spine surgery

Methods: We conducted a retrospective analysis of 1,132 patients who underwent spine surgery between August 2015 and August 2023. Socioeconomic status was assessed using Area Deprivation Index (ADI) and household income. The primary outcomes were opioid prescription rates at 3 and 12 months post-surgery. Chi-square tests, t-tests, and Tukey's HSD post-hoc analyses were performed to evaluate associations between socioeconomic factors, clinical characteristics, and opioid prescriptions.

Results: Significant associations were found between 3-month opioid prescriptions and gender (p=0.0079), mental health status (p < 0.0001), fusion status (p=0.0004), and procedure type (p < 0.0001). Males and patients with mental health conditions were more likely to receive prescriptions. While overall household income was not significantly associated with prescriptions (p=0.9016), patients in lower income brackets showed higher prescription rates. ADI analysis revealed significant associations in lower to middle percentiles (p < 0.05). At 12 months, these associations were less pronounced. Preoperative narcotic use (p < 0.0001) and complex procedures were associated with higher prescription rates at both time points. 15.52% of patients received prescriptions at both 3 and 12 months.

Conclusion : Socioeconomic factors and clinical characteristics influence short-term postoperative opioid use following spine surgery, but their impact on long-term use is less pronounced. These findings highlight the need for targeted interventions in the early postoperative period and comprehensive, individualized approaches to long-term pain management that address the complex interplay of socioeconomic, clinical, and patient-specific factors.