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Under-utilisation of demographic and social variables in the analysis of postoperative opioid use after lumbar fusion: a rapid review

Year: 2026

Type: article

Abstract: Objectives Limited research has explored how demographic and social factors affect opioid use after lumbar fusion. This review quantifies how frequently patient-level factors are reported in the literature. It also summarises findings from observational studies that use these factors to analytically evaluate how patient-level factors influence opioid use after lumbar fusion.Methods Medline (via PubMed) was comprehensively searched to identify studies published between 1 January 2015 and 18 April 2025 that reported either opioid consumption or time to rescue analgesia after lumbar fusion. Randomised controlled trials, studies with paediatric patients and studies in which lumbar fusion was not disaggregated from other surgeries were excluded. From each eligible article, data regarding patient-level factors were extracted, and proportions of articles reporting and analysing each variable were calculated.Results 70 publications met all eligibility criteria. Age (98.6%) and sex (98.6%) were routinely reported, whereas psychiatric comorbidities (25.7%), race (24.3%), insurance status (21.4%), ethnicity (5.7%), urban versus rural residence (5.7%), employment status (1.4%) and education level (1.4%) were more rarely reported. Only 5.7% of studies analysed sex and age as predictors of pain management, 2.9% examined psychiatric comorbidities and 1.4% assessed race or insurance status; none evaluated ethnicity, urban versus rural residence, employment, education, area deprivation index, social vulnerability index, household income, English proficiency or immigration status.Discussion The publications analysed within this review found older age consistently predicted decreased opioid consumption, whereas findings related to sex were mixed. However, any interpretation regarding the impact of patient-level factors on opioid use after lumbar fusion is constrained by the scarcity of studies that have statistically analysed these associations and the strict inclusion criteria of the study, which required opioid consumption to be quantified in a standardised format, that is, morphine milligram equivalents.

Source: BMJ Open Quality

DOI: 10.1136/bmjoq-2026-004276