Lumbar discectomy patients with a criminal incarceration history are at risk of higher postoperative opioid utilization, emergency department visits, and adverse events.

Background: Nearly 700,000 individuals are released from US correctional facilities annually. Those with a history of criminal incarceration (HCI) experience inferior health outcomes related to limited healthcare access, chronic disease burden, and economic marginalization. These inequities may increase complications following spine surgery, such as lumbar discectomy (LD); however, postoperative outcomes in this population remain unknown. Methods: Patients undergoing single-level LD between 2016 and 2023 were identified from a large, national, multi-insurance claims database. Exclusion criteria included: age <18, concurrent lumbar procedures, multilevel surgery, <90-day follow-up, or trauma, neoplasm, or infection within 90 days preoperatively. Patients were stratified by documented prior incarceration, imprisonment, or problems related to prison release. (+)HCI patients were matched 1:4 to (-)HCI controls by age, sex, and comorbidity burden. Multivariable logistic regression assessed associations between HCI and social determinants of health, as well as 90-day postoperative outcomes. Five-year reoperation was evaluated using Kaplan-Meier survival analysis. Results: HCI was identified in 146 LD patients; after matching, 141 (+)HCI and 551 (-)HCI patients remained. Relative to matched controls, (+)HCI patients demonstrated higher odds of housing insecurity (odds ratio [OR] 4.62, p<.001), economic inequality (OR 4.25, p<.001), and unemployment (OR 3.82, p=.001), with no differences in Medicaid (p=.260) or Medicare coverage (p=.288), relative to commercial insurance. Postoperatively, (+)HCI patients were prescribed higher opioid morphine milligram equivalents (+361.8, p=.022) and had greater odds of emergency department visits (OR 2.83, p<.001) and minor adverse events (OR 2.46, p=.006). No differences were observed in readmission (p=.082) or 5-year reoperation (4.1% vs. 2.5%, p=.100). Conclusions: Among the largest spine surgery cohort to date with a criminal incarceration history, LD patients with HCI were associated with substantial social determinants of health barriers, increased postoperative opioid exposure, emergency department utilization, and complications. These inequities warrant attention within postoperative care pathways and underscore the need for further investigation to optimize support strategies for this vulnerable and growing population.