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Concerns over postoperative opioid use after open spinal fusion continue to rise. Many randomized controlled trials (RCTs) have sought to reduce postoperative opioid consumption; however, the influence of sociodemographic variables on this consumption remains underappreciated. This study evaluated the extent to which sociodemographic characteristics are reported in RCTs assessing postoperative opioid consumption following lumbar fusion surgery.

A structured literature search (Medline via PubMed, 2015-2025) was conducted to identify English-language RCTs focused on postoperative opioid use after open lumbar fusion. Exposures of interest included demographics, insurance status, education level, and prior opioid use; the primary outcome was postoperative opioid consumption. Following full-text review of 321 articles, 63 RCTs met inclusion criteria for data extraction. Reported variables included sex (96.8%), age (93.7%), preoperative opioid history (19.0%), race (6.3%), psychiatric comorbidity (6.3%), employment (3.2%), and insurance status, ethnicity, and education (1.6% each). Reporting of preoperative opioid history was associated with North American or European trial settings (adjusted p = 0.017).

Sociodemographic underreporting limits interpretability of postoperative opioid outcomes in lumbar fusion RCTs. Greater inclusion of patient-level variables is needed to advance interpretability of postoperative opioid consumption in lumbar fusion RCTs.