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

Background: Factors influencing opioid prescribing include provider type, clinical experience, regional patterns, and institutional affiliation. This study compared the rates of chronic opioid prescriptions being given to older adults undergoing long-segment posterior lumbar fusions in academic versus nonacademic centers.

Methods: Out of 20,719 patients aged ≥65 years who underwent posterior lumbar instrumentation involving 3-12 thoracolumbar levels (2010-2022), we created two matched groups that included 3,904 patients each. Patients were stratified according to whether they were treated in academic versus nonacademic centers. Matching included the utilization of 1:1 demographic and clinical factors and analyzed for opioid prescribing patterns at 3-6, 6-12, and 12-24 months postoperatively.

Results: We found that patients operated on in nonacademic centers showed significantly lower odds of receiving codeine-based opioids at 3-6 and 6-12 months postoperatively. Conversely, at 12-24 postoperative months, these patients had increased odds of receiving noncodeine-based, strong, and moderate opioids versus academic center patients.

Conclusion: For two cohorts of 3904 adults over 65 years of age undergoing 3-12 level thoracolumbar instrumented fusions, academic centers prescribed more opioids initially postoperatively, while nonacademic centers demonstrated higher long-term usage.