Prolonged Preoperative Opioid Therapy Associated With Poor Return to Work Rates After Single-Level Cervical Fusion for Radiculopathy for Patients Receiving Workers' Compensation Benefits

作者：Faour Mhamad^*; Anderson Joshua T; Haas Arnold R; Percy Rick; Woods Stephen T; Ahn Uri M; Ahn Nicholas U

来源：Spine, 2017, 42(2): E104-E110.

DOI：10.1097/BRS.0000000000001715

• absent from work
• analgesics
• cervical fusion
• cervical spine
• chronic opioid use
• degenerative disc disease
• legal litigation
• long-term opioids
• narcotic
• opioids
• oral opioids
• permanent disability
• preoperative opioid use
• radiculopathy
• reoperation
• return to work
• short-term opioids
• single-level fusion
• surgical complications
• workers' compensation
• workplace injury
• work-related injury

Study Design. Retrospective comparative cohort study.
Objective. Examine the effect of prolonged preoperative opioid use on return to work (RTW) status after single-level cervical fusion for radiculopathy.
Summary of Background Data. The use of opioids has a dramatic effect in a workers' compensation population. The costs of claims that involved opioids in the management plan are catastrophic particularly for those undergoing spinal surgical procedure.
Materials. Data of patients who underwent single-level cervical fusion for radiculopathy and had received opioid prescriptions before surgery were retrospectively collected from Ohio Bureau of Workers' Compensation between 1993 and 2011 after work-related injury. Then, based on opioid use duration, short-term use (STO) group (<3 mo), intermediate-term use (ITO) group (3-6 mo), and long-term use (LTO) group (>6 mo) were constructed. A multivariate logistic regression analysis was used to determine whether successful RTW status was achieved. Chi-square and analysis of variance tests were used to compare other secondary outcomes after surgery.
Results. Prolonged preoperative opioid use was a negative predictor of successful RTW status (odds ratio = 0.73; 95% confidence interval: 0.55-0.98; P value: 0.04). Prolonged preoperative opioid use was associated with increasingly lower rates of achieving stable RTW status (P<0.05) and RTW within 1 year after surgery (P<0.05). The odds of achieving successful RTW status were 0.49 (0.25-0.94) for ITO, and 0.40 (0.24-0.68) for LTO compared with STO group. The odds of RTW less than 1 year after surgery were 0.43 (0.21-0.88) for ITO and 0.36 (0.21-0.62) for LTO compared with STO group. Prolonged preoperative opioid use was also associated with increasingly higher net medical costs (P<0.01), and disability benefits awarded after surgery (P<0.01).
Conclusion. Prolonged preoperative opioid use was associated with poor functional outcomes after cervical fusion. STO and earlier inclusion of the surgical approach in the management plan may offer better surgical and functional outcomes after cervical fusion.

• 出版日期2017-1-15