Retrospective, database review.The purpose of this study was to explore the association between preoperative opioid use and postoperative infection requiring operative wound washout in elective lumbar fusion patients.Numerous peer-reviewed publications have conducted multivariate analyses of risk factors for surgical site infection. However, few have explored preoperative opioid use. Opioids have been widely prescribed preoperatively for pain management, but their effect on postsurgical infection is currently inconclusive.We retrospectively queried the PearlDiver national insurance claims database and included patients from 2007-2017 with a history of lumbar fusion. Any interbody fusion history designated exclusion. We stratified patients by single or multilevel procedures and conducted univariate analyses of previously documented infection risk factors, as well as our variable of interest, chronic preoperative opioid use. Variables associated (p < 0.100) with the outcome measure of 90-day postoperative infection treated with operative irrigation and wound debridement were included in a multivariate analysis.A total of 12,519 patients matched our inclusion criteria. Amongst the single level cohort, only diabetes was observed to be associated with infection requiring operative wound washout and thus no subsequent regression was performed. For the cohort of patients who underwent multilevel fusion, chronic opioid use, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension trended towards significance in the univariate analysis and were included in a logistic regression model. In the multivariate analysis, chronic opioid use (OR = 1.435, p = 0.025), diabetes (OR = 1.591 p = 0.003), and congestive heart failure (OR = 1.929, p = 0.003) were identified as independent risk factors for infection requiring operative wound washout.In this analysis, preoperative opioid use was significantly associated with infection requiring operative wound washout in multilevel lumbar fusion patients. Limiting opioid consumption may have the benefit of reducing the risk of infection following spine surgery.3.