The association between postoperative physical therapy and opioid prescription after posterior lumbar interbody fusion: a retrospective cohort study of United States academic health centers.

Purpose: This study evaluates whether early postoperative physical therapy (PT) reduces the risk and quantity of opioid prescriptions and the development of opioid-related disorders within the first year after posterior lumbar interbody fusion (PLIF).

Methods: We analyzed de-identified U.S. records (TriNetX, Inc.) of opioid-naïve adults with lumbar stenosis who underwent PLIF (2014-2023). Patients were grouped by PT received within two months post-surgery and propensity matched according to variables associated with opioid prescription. Outcomes included the risk ratio (RR) and mean number of opioid prescriptions, along with the incidence and RR of new opioid-related disorders in the first year.

Results: After matching, there were 4,031 patients per cohort with adequately matched covariates. Compared to patients in the no postoperative PT cohort, in the first year after primary PLIF, patients in the postoperative PT cohort had a statistically significant lower risk of oral opioid prescription [95% CI] (62.6% versus 73.4%; RR: 0.85 [0.83,0.88]; p < 0.0001), a statistically significant lower mean count of oral opioid prescriptions (2.8 versus 3.7; p < 0.0001), and a statistically significant lower risk of a new diagnosis of an opioid-related disorder (0.72% versus 1.5%; RR: 0.49 [0.32,0.77]; p = 0.0013).

Conclusion: Our findings support that postoperative PT after PLIF is associated with a lower risk and reduced number of opioid prescriptions, as well as a decreased risk of opioid-related disorders in the first postoperative year. These results should be validated by prospective trials that also explore the optimal timing of PT and its impact on opioid use and related disorders.