Chronic opioid prescription rates following long-segment lumbar instrumentation: A comparison of academic and nonacademic centers

Background: Postoperative opioid prescribing after spine surgery varies widely, and institutional factors such as academic center status may influence long-term opioid use. Understanding these differences is important for improving opioid stewardship following complex lumbar procedures. Methods: A retrospective cohort study using the TriNetX Research Network evaluated chronic postoperative opioid prescribing after long-segment posterior lumbar instrumentation. Patients undergoing posterior lumbar instrumentation spanning 3 to 12 vertebral segments between 2010 and 2022 were stratified by treatment at academic or nonacademic centers. Propensity score matching balanced cohorts for demographics, comorbidities, and preoperative analgesic use. Opioid prescriptions were assessed at 3 to 6 months, 6 to 12 months, and 12 to 24 months postoperatively and categorized by metabolic class and strength. Logistic regression compared postoperative opioid prescribing between cohorts. Results: After propensity score matching, 7,883 patients were included in each cohort. At 3 to 6 months postoperatively, patients treated at nonacademic centers had lower odds of receiving opioids compared to those treated at academic centers, including lower odds of codeine-based opioids (OR: 0.77, 95% CI: 0.71-0.82) and weak opioids (OR: 0.71, 95% CI: 0.63-0.79). At 6 to 12 months, patients at nonacademic centers demonstrated higher odds of receiving non-codeine-based opioids (OR: 1.20, 95% CI: 1.10-1.31). At 12 to 24 months postoperatively, treatment at nonacademic centers was associated with higher odds of non-codeine-based opioids (OR: 1.26, 95% CI: 1.17-1.36), strong opioids (OR: 1.17, 95% CI: 1.08-1.25), and moderate opioids (OR: 1.11, 95% CI: 1.02-1.21). Conclusions: Postoperative opioid prescribing following long-segment lumbar instrumentation differs between academic and nonacademic centers and varies over time. These findings highlight institutional variation in long-term opioid prescribing and underscore the need for further studies to identify drivers of these differences and optimize postoperative pain management strategies.