Research ArticleLumbar Spine

Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis

Aneysis D. Gonzalez-Suarez, Allen Green, María José Cavagnaro, Emily Moya, Corinna Zygourakis and Atman M. Desai
International Journal of Spine Surgery April 2025, 19 (2) 224-236; DOI: https://doi.org/10.14444/8732

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Distribution of nonsteroidal anti-inflammatory drug (NSAID) dispensation across postsurgical time intervals based on the timing of NSAID initiation. Heatmaps represent the distribution of NSAIDs dispensation across various time intervals postsurgery for different cohorts based on the timing of NSAIDs initiation. (A) NSAIDs started between 0 and 72 h of surgery with various day supply prescribed. (B) As in (A), but for patients who began NSAIDs between 72 h and 90 d postsurgery. (C) As in (A), but for patients who began NSAIDs between 90 d and 1 y postsurgery. The color intensity reflects the number of patients, with warmer colors indicating higher patient frequency and cooler colors indicating lower frequency. The x-axis shows the NSAIDs dispensation intervals (1–3 d, 4–7 d, 8–30 d, 31–90 d, 91–180 d, 181–365 d, 366–720 d), and the y-axis lists the specific NSAIDs and their dosages administered.

  • Figure 2
    Figure 2

    Selection criteria flow chart for the posterior lumbar fusion (PLF) cohort depicting the selection inclusion and exclusion criteria for the final PLF patients in the study.

Tables

  • Table 1

    Demographics and clinical characteristics of PLF patients with NSAIDs use ≤ 72 h, 72 h to 90 d, or 90 d to 1 y after surgery.

    VariableNSAIDs ≤72 h
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)52.01 (9.32)52.00 (9.32)0.06352.01 (9.32)51.42 (9.52)0.010
    Gender, woman, n (%)25,844 (54.12%)26,340 (54.17%)0.05425,844 (54.12%)496 (56.82%)0.001
    Comorbidities, n (%)      
     CHF1612 (3.38%)1636 (3.36%)0.0351612 (3.38%)24 (2.75%)0.008
     Diabetes10,372 (21.72%)10,572 (21.74%)0.02910,372 (21.72%)200 (22.91%)0.001
     CPD6967 (14.59%)7102 (14.61%)0.0256967 (14.59%)135 (15.46%)0.009
     Tumors93 (0.19%)98 (0.20%)0.08493 (0.19%)<110.001
     PVD2418 (5.06%)2448 (5.03%)0.0742418 (5.06%)30 (3.44%)0.004
     PUD211 (0.44%)214 (0.44%)0.015211 (0.44%)<110.002
     Stroke697 (1.46%)708 (1.46%)0.017697 (1.46%)11 (1.26%)0.002
     Renal disease567 (1.19%)574 (1.18%)0.036567 (1.19%)<110.003
     Dementia34 (0.07%)37 (0.08%)0.09934 (0.07%)<110.003
     Liver disease2552 (5.34%)2605 (5.36%)0.0322552 (5.34%)53 (6.07%)0.005
     Paralysis452 (0.95%)468 (0.96%)0.091452 (0.95%)16 (1.83%)0.004
     Rheumatoid arthritis2637 (5.52%)2722 (5.60%)0.1832637 (5.52%)85 (9.74%)0.002
     HIV32 (0.07%)34 (0.07%)0.06132 (0.07%)<110.001
     MI146 (0.31%)148 (0.30%)0.014146 (0.31%)<110.004
    VariableNSAIDs 72 h to 90 d
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)52.01 (9.32)52.31 (9.15)0.17852.01 (9.32)53.64 (8.20)0.008
    Gender, woman, n (%)25,844 (54.12%)32,247 (55.33%)0.13525,844 (54.12%)6403 (60.83%)0.001
    Comorbidities, n (%)      
     CHF1612 (3.38%)1988 (3.41%)0.0111612 (3.38%)376 (3.57%)0.005
     Diabetes10,372 (21.72%)13,061 (22.41%)0.09210,372 (21.72%)2689 (25.55%)0.005
     CPD6967 (14.59%)8792 (15.09%)0.0776967 (14.59%)1825 (17.34%)0.004
     Tumors93 (0.19%)106 (0.18%)0.01793 (0.19%)13 (0.12%)0.000
     PVD2418 (5.06%)3022 (5.19%)0.0302418 (5.06%)604 (5.74%)0.000
     PUD211 (0.44%)269 (0.46%)0.016211 (0.44%)58 (0.55%)0.005
     Stroke697 (1.46%)853 (1.46%)0.002697 (1.46%)156 (1.48%)0.004
     Renal disease567 (1.19%)632 (1.08%)0.055567 (1.19%)65 (0.62%)0.012
     Dementia34 (0.07%)42 (0.07%)0.00234 (0.07%)<110.004
     Liver disease2552 (5.34%)3198 (5.49%)0.0352552 (5.34%)646 (6.14%)0.004
     Paralysis452 (0.95%)588 (1.01%)0.035452 (0.95%)136 (1.29%)0.000
     Rheumatoid arthritis2637 (5.52%)3738 (6.41%)0.2022637 (5.52%)1101 (10.46%)0.001
     HIV32 (0.07%)42 (0.07%)0.01032 (0.07%)<110.003
     MI146 (0.31%)187 (0.32%)0.015146 (0.31%)41 (0.39%)0.005
    VariableNSAIDs 90 d to 1 y
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)52.01 (9.32)52.04 (9.25)0.01652.01 (9.32)52.16 (9.00)0.002
    Gender, man, n (%)25,844 (54.12%)34,125 (55.59%)0.13325,844 (54.12%)8281 (60.74%)0.000
    Comorbidities, n (%)      
     CHF1612 (3.38%)2062 (3.36%)0.0041612 (3.38%)450 (3.30%)0.000
     Diabetes10,372 (21.72%)13,333 (21.72%)0.00010,372 (21.72%)2961 (21.72%)0.001
     CPD6967 (14.59%)9219 (15.02%)0.0546967 (14.59%)2252 (16.52%)0.001
     Tumors93 (0.19%)112 (0.18%)0.01393 (0.19%)19 (0.14%)0.000
     PVD2418 (5.06%)3142 (5.12%)0.0112418 (5.06%)724 (5.31%)0.001
     PUD211 (0.44%)281 (0.46%)0.011211 (0.44%)70 (0.51%)0.000
     Stroke697 (1.46%)877 (1.43%)0.012697 (1.46%)180 (1.32%)0.001
     Renal disease567 (1.19%)675 (1.10%)0.038567 (1.19%)108 (0.79%)0.002
     Dementia34 (0.07%)47 (0.08%)0.00934 (0.07%)13 (0.10%)0.000
     Liver disease2552 (5.34%)3404 (5.55%)0.0402552 (5.34%)852 (6.25%)0.000
     Paralysis452 (0.95%)564 (0.92%)0.013452 (0.95%)112 (0.82%)0.001
     Rheumatoid arthritis2637 (5.52%)3725 (6.07%)0.1032637 (5.52%)1088 (7.98%)0.001
     HIV32 (0.07%)45 (0.07%)0.01032 (0.07%)13 (0.10%)0.000
     MI146 (0.31%)180 (0.29%)0.010146 (0.31%)34 (0.25%)0.001

    • Abbreviations: CHF, congestive heart failure; CPD, chronic pulmonary disease; HIV, human immunodeficiency virus; IPTW, inverse probability of treatment weighting; MI, myocardial infarction; NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion; PUD, peptic ulcer disease; PVD, peripheral vascular disease; SMD, standardized mean difference.

    • Note: Cells with fewer than 11 patients were not reported or inferred per the data use agreement.

  • Table 2

    Demographics of patients who received NSAIDs after uncomplicated, single-level PLF surgery at 3 different time windows.

    VariableNSAIDs <72 h
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)51.57 (9.31)51.57 (9.31)0.03951.57 (9.31)51.21 (9.28)0.013
    Gender, woman, n (%)15,187 (56.04%)15,513 (56.12%)0.08315,187 (56.04%)326 (60.15%)0.001
    Comorbidities, n (%)      
     CHF884 (3.26%)897 (3.24%)0.049884 (3.26%)13 (2.40%)0.000
     Diabetes5594 (20.64%)5712 (20.66%)0.0285594 (20.64%)118 (21.77%)0.021
     CPD3907 (14.42%)3988 (14.43%)0.0153907 (14.42%)81 (14.94%)0.015
     Tumors24 (0.09%)28 (0.10%)0.20424 (0.09%)14 (0.74%)0.000
     PVD1338 (4.94%)1355 (4.90%)0.0831338 (4.94%)17 (3.14%)0.013
     PUD132 (0.49%)132 (0.48%)0.071132 (0.49%)11 (0.06%)0.070
     Stroke382 (1.41%)390 (1.41%)0.006382 (1.41%)18 (1.48%)0.007
     Renal disease287 (1.06%)288 (1.04%)0.086287 (1.06%)11 (0.18%)0.012
     Dementia21 (0.08%)23 (0.08%)0.10121 (0.08%)12 (0.37%)0.012
     Liver disease1422 (5.25%)1456 (5.27%)0.0461422 (5.25%)34 (6.27%)0.002
     Paralysis199 (0.73%)208 (0.75%)0.107199 (0.73%)19 (1.66%)0.006
     Rheumatoid arthritis1463 (5.40%)1519 (5.50%)0.2171463 (5.40%)56 (10.33%)0.012
     HIV15 (0.06%)17 (0.06%)0.12715 (0.06%)12 (0.37%)0.000
     MI77 (0.28%)78 (0.28%)0.01977 (0.28%)11 (0.18%)0.007
    VariableNSAIDs 72 h to 90 d
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)51.57 (9.31)51.84 (9.15)0.16751.57 (9.31)53.10 (8.25)0.009
    Gender, woman, n (%)15,187 (56.04%)18,829 (57.19%)0.13115,187 (56.04%)3642 (62.55%)0.003
    Comorbidities, n (%)     
     CHF884 (3.26%)1073 (3.26%)0.001884 (3.26%)189 (3.25%)0.005
     Diabetes5594 (20.64%)7031 (21.36%)0.0985594 (20.64%)1437 (24.68%)0.005
     CPD3907 (14.42%)4921 (14.95%)0.0843907 (14.42%)1014 (17.41%)0.001
     Tumors24 (0.09%)29 (0.09%)0.00124 (0.09%)24 (0.09%)0.002
     PVD1338 (4.94%)1672 (5.08%)0.0361338 (4.94%)334 (5.74%)0.001
     PUD132 (0.49%)165 (0.50%)0.011132 (0.49%)33 (0.57%)0.002
     Stroke382 (1.41%)463 (1.41%)0.002382 (1.41%)81 (1.39%)0.000
     Renal disease287 (1.06%)319 (0.97%)0.052287 (1.06%)32 (0.55%)0.013
     Dementia21 (0.08%)27 (0.08%)0.00921 (0.08%)21 (0.08%)0.005
     Liver disease1422 (5.25%)1768 (5.37%)0.0311422 (5.25%)346 (5.94%)0.007
     Paralysis199 (0.73%)268 (0.81%)0.050199 (0.73%)69 (1.18%)0.001
     Rheumatoid arthritis1463 (5.40%)2062 (6.26%)0.2021463 (5.40%)599 (10.29%)0.001
     HIV15 (0.06%)20 (0.06%)0.01215 (0.06%)15 (0.06%)0.003
     MI77 (0.28%)103 (0.31%)0.02977 (0.28%)26 (0.45%)0.005
    VariableNSAIDs 90 d to 1 y
    Before IPTWAfter IPTW
    ControlInterventionSMDControlInterventionSMD
    Age, y, mean (SD)51.57 (9.31)51.53 (9.28)0.02151.57 (9.31)51.37 (9.19)0.001
    Gender, man, n (%)15,187 (56.04%)19,989 (57.40%)0.12415,187 (56.04%)4802 (62.16%)0.001
    Comorbidities, n (%)      
     CHF884 (3.26%)1137 (3.26%)0.001884 (3.26%)253 (3.28%)0.002
     Diabetes5594 (20.64%)7191 (20.65%)0.0015594 (20.64%)1597 (20.67%)0.002
     CPD3907 (14.42%)5251 (15.08%)0.0833907 (14.42%)1344 (17.40%)0.000
     Tumors24 (0.09%)30 (0.09%)0.00424 (0.09%)24 (0.09%)0.002
     PVD1338 (4.94%)1724 (4.95%)0.0031338 (4.94%)386 (5.00%)0.002
     PUD132 (0.49%)174 (0.50%)0.008132 (0.49%)42 (0.54%)0.000
     Stroke382 (1.41%)481 (1.38%)0.011382 (1.41%)99 (1.28%)0.001
     Renal disease287 (1.06%)348 (1.00%)0.027287 (1.06%)61 (0.79%)0.004
     Dementia21 (0.08%)31 (0.09%)0.01721 (0.08%)11 (0.13%)0.000
     Liver disease1422 (5.25%)1917 (5.50%)0.0511422 (5.25%)495 (6.41%)0.000
     Paralysis199 (0.73%)249 (0.71%)0.010199 (0.73%)50 (0.65%)0.002
     Rheumatoid arthritis1463 (5.40%)2075 (5.96%)0.1071463 (5.40%)612 (7.92%)0.002
     HIV15 (0.06%)21 (0.06%)0.00915 (0.06%)15 (0.06%)0.000
     MI77 (0.28%)99 (0.28%)0.00077 (0.28%)22 (0.28%)0.002

    • Abbreviations: CHF, congestive heart failure; CPD, chronic pulmonary disease; HIV, human immunodeficiency virus; IPTW, inverse probability of treatment weighting; MI, myocardial infarction; NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion; PUD, peptic ulcer disease; PVD, peripheral vascular disease; SMD, standardized mean difference.

    • Note: Cells with less than 11 patients were not reported or inferred per the data use agreement.

  • Table 3

    Complication rates in PLF patients after NSAIDs use.

    ComplicationNSAIDs <72 h
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission47,7548730.8830.6311.2370.470
    Pseudoarthrosis and hardware failure47,7548731.1981.0201.4080.028
    Wound complications47,754873 0.692 0.538 0.889 0.004
    Length of stay47,754873 0.736 0.706 0.768 <0.001
    ComplicationNSAIDs 72 h to 90 d
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission47,75410,5261.0110.9621.0630.666
    Pseudoarthrosis and hardware failure47,75410,526 1.042 1.017 1.068 0.001
    Wound complications47,75410,526 1.069 1.035 1.105 <0.001
    ComplicationNSAIDs 90 d to 1 y
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission47,75413,6331.0200.9901.0510.186
    Pseudoarthrosis and hardware failure47,75413,633 1.024 1.009 1.039 0.002
    Wound complications47,75413,6331.0010.9801.0210.941

    • Abbreviations: IRR, incidence rate ratio; NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion.

    • Note: Bold values indicate a significance at a Bonferroni-adjusted P value of <0.01.

  • Table 4

    Complication rates in PLF patients starting NSAIDs use <72 h with different dispensing intervals.

    ComplicationNSAIDs Days Dispensed (1–30 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,7544520.8030.4941.3060.376
    Pseudoarthrodesis and hardware failure47,7544521.2290.9811.5380.072
    Wound complications47,754452 0.571 0.391 0.832 0.004
    ComplicationNSAIDs Days Dispensed (31–90 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,7541500.7080.2901.7290.449
    Pseudoarthrodesis and hardware failure47,7541501.0770.7401.5680.698
    Wound complications47,7541500.8570.4941.4870.583
    ComplicationNSAIDs Days Dispensed (91–180 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,754821.0530.3852.8800.919
    Pseudoarthrodesis and hardware failure47,754821.8050.9983.2660.051
    Wound complications47,754821.0260.5132.0530.941
    ComplicationNSAIDs Days Dispensed (181–365 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,7541451.0420.4872.2290.916
    Pseudoarthrodesis and hardware failure47,7541451.1100.7561.6310.594
    Wound complications47,7541450.6830.3691.2650.225
    ComplicationNSAIDs Days Dispensed (366–720 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,754441.5030.4654.8570.496
    Pseudoarthrodesis and hardware failure47,754440.9070.4671.7620.773
    Wound complications47,754440.8330.2982.3280.727

    • Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion.

    • Note: Bold values indicate a significance at a Bonferroni-adjusted P value of ≤0.01

  • Table 5

    Complication rates in uncomplicated, single-level PLF patients after NSAIDs use.

    ComplicationNSAIDs <72 h
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission27,1015420.8360.5061.3800.483
    Pseudoarthrosis and hardware failure27,1015421.0680.8821.2940.500
    Wound complications27,1015420.8390.5991.1750.308
    Length of stay27,101542 0.757 0.715 0.801 <0.001
    ComplicationNSAIDs 72 h to 90 d
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission27,10158231.0290.9541.1090.462
    Pseudoarthrosis and hardware failure27,1015823 1.048 1.015 1.082 0.004
    Wound complications27,1015823 1.150 1.097 1.206 <0.001
    ComplicationNSAIDs 90 d to 1 y
    N Control N InterventionOR/IRRCI LowerCI Upper P
    Readmission27,10177251.0320.9871.0780.167
    Pseudoarthrosis and hardware failure27,1017725 1.038 1.019 1.058 <0.001
    Wound complications27,10177251.0200.9891.0520.202

    • Abbreviations: IRR, incidence rate ratio; NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion.

    • Note: Bold values indicate a significance at a Bonferroni-adjusted P value of <0.01.

  • Table 6

    Complication rates in PLF patients starting NSAIDs use 72 h to 90 d with different dispensing intervals.

    ComplicationNSAIDs Days Dispensed (1–30 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,7543096 1.313 1.125 1.532 0.001
    Pseudoarthrodesis and hardware failure47,75430960.9840.9061.0700.712
    Wound complications47,7543096 1.427 1.286 1.583 <0.001
    ComplicationNSAIDs Days Dispensed (31–90 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75420740.8990.7231.1190.342
    Pseudoarthrodesis and hardware failure47,75420741.0140.9161.1220.790
    Wound complications47,75420741.1150.9731.2780.117
    ComplicationNSAIDs Days Dispensed (91–180 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75416160.9160.7171.1700.483
    Pseudoarthrodesis and hardware failure47,75416161.1261.0011.2660.048
    Wound complications47,75416160.9530.8101.1220.564
    ComplicationNSAIDs Days Dispensed (181–365 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75434080.8930.7511.0620.201
    Pseudoarthrodesis and hardware failure47,7543408 1.212 1.114 1.317 <0.001
    Wound complications47,75434081.0020.8951.1210.977
    ComplicationNSAIDs Days Dispensed (366–720 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,7543320.9720.5781.6340.914
    Pseudoarthrodesis and hardware failure47,7543321.2280.9451.5960.124
    Wound complications47,7543321.1730.8451.6290.341

    • Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion.

    • Note: Bold values indicate a significance at a Bonferroni-adjusted P value of ≤0.01.

  • Table 7

    Complication rates in PLF patients starting NSAIDs use 90 d to 1 y with different dispensing intervals.

    ComplicationNSAIDs Days Dispensed (1–30 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75472191.0210.9091.1480.721
    Pseudoarthrodesis and hardware failure47,75472191.0390.9811.1000.196
    Wound complications47,75472190.9520.8781.0330.239
    ComplicationNSAIDs Days Dispensed (31–90 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75433141.0830.9211.2730.333
    Pseudoarthrodesis and hardware failure47,75433141.0961.0091.1900.030
    Wound complications47,75433140.9770.8711.0960.688
    ComplicationNSAIDs Days Dispensed (91–180 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75418980.9990.8031.2420.990
    Pseudoarthrodesis and hardware failure47,7541898 1.154 1.035 1.287 0.010
    Wound complications47,75418981.0640.9201.2290.405
    ComplicationNSAIDs Days Dispensed (181–365 d)
    N Control N InterventionORCI LowerCI Upper P
    Readmission47,75411931.3581.0691.7250.012
    Pseudoarthrodesis and hardware failure47,75411931.1040.9641.2640.152
    Wound complications47,75411931.2991.0971.5370.020

    • Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; PLF, posterior lumbar fusion.

    • Note: Bold values indicate a significance at a Bonferroni-adjusted P value of ≤0.01.

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Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis
Aneysis D. Gonzalez-Suarez, Allen Green, María José Cavagnaro, Emily Moya, Corinna Zygourakis, Atman M. Desai
International Journal of Spine Surgery Apr 2025, 19 (2) 224-236; DOI: 10.14444/8732
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