The Impact of Alcohol, Nicotine, and Opioid Use History on 90-Day and 1-Year Postoperative Complications Following Elective Laminectomy: A Nationwide Propensity-Matched Study

Study Design Retrospective cohort study. Objectives To assess the effect of alcohol, nicotine, and opioid use history on 90 day and 1 year postoperative complications after elective laminectomy. Methods Using the TriNetX Database (2004-2025), adult patients undergoing elective laminectomy were divided into cohorts with a history of alcohol, nicotine, or opioid abuse/dependence, matched 1:1 with controls (age, sex, race, body mass index, comorbidities). Exclusions included malignancy, preceding trauma, and prior complications. Outcomes included the development of acute kidney failure, sepsis, emergency department visits, deep vein thrombosis, myocardial infarction, pulmonary embolism, pneumonia, stroke, and mortality at 90 days and 1 year. Results Matched cohorts comprised 4053 alcohol, 22 469 nicotine, and 2724 opioid patients, each with controls. Alcohol abuse was significantly associated with increased odds of death, DVT, MI, pneumonia, sepsis, and stroke following elective laminectomy at 90 days, and with acute renal failure, PE, pneumonia, stroke, sepsis, DVT, and death at 1 year ( P < 0.05). Nicotine dependence significantly elevated the risk of death, MI, pneumonia, and sepsis at 90 days, and at 1 year, remained associated with increased odds of acute renal failure, stroke, ED visits, MI, pneumonia, sepsis, and death ( P < 0.05). Opioid abuse was significantly linked to higher risks of DVT, MI, pneumonia, sepsis, stroke, and death at 90 days, with persistent 1-year risks for acute renal failure, MI, pneumonia, sepsis, and death ( P < 0.05). Conclusions Alcohol, nicotine, and opioid use significantly heighten postoperative complications after laminectomy, underscoring the need for preoperative risk evaluation and tailored interventions.