Does Gabapentin Use Following ACDF Decrease Opioid Utilization? A Retrospective Propensity-Matched Analysis Conducted in Academic Medical Centers

Study Design Retrospective Propensity-Matched Analysis. Objectives Optimal control of postoperative pain while minimizing opioid consumption is paramount in spine surgery. While gabapentinoids have robust utilization for the treatment of neuropathic pain and neuroprotective effects, their interplay in multimodal analgesia following ACDF is unclear. The objective of the present study was to investigate the association between postoperative gabapentinoid use and postoperative opioid use following ACDF. Methods We conducted a retrospective cohort study using the TriNetX Research network, identifying adult patients who underwent ACDF between 2003-2023. Patients with chronic opioid use were excluded. After 1:1 propensity score matching, cohorts were constructed based on receipt of postoperative gabapentinoids vs acetaminophen monotherapy. Outcomes included opioid utilization and surgical/systemic complications across standardized follow-up intervals (30 days, 90 days, 6 months, 1 year, 2 years, and 5 years). Risk ratios with 95% confidence intervals were calculated, and Kaplan-Meier analyses assessed time-to-event outcomes. Results After matching, 32 455 patients were included in each group. Gabapentinoid use was associated with higher opioid consumption at every interval, persisting through 5 years (2.29% vs 0.51% at 5 years, RR 4.61, P < 0.001). Gabapentinoid recipients had a greater risk of pneumonia and respiratory failure across multiple timepoints. Kaplan-Meier curves demonstrated durable separation between groups for pneumonia, respiratory failure, and opioid use (all log-rank P < 0.001). Conclusion Gabapentinoids use following ACDF was associated with increased opioid utilization and higher complication rates, challenging their presumed benefit in this setting. These findings suggest that gabapentinoids may not be an effective adjunct in multimodal pain regimens for ACDF.