Faour Mhamad, Anderson Joshua T, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Orthopedics. 2017 Jan 1;40(1):25-32. doi: 10.3928/01477447-20161013-02. Epub 2016 Oct 18.
The use of opioids among patients with workers' compensation claims is associated with tremendous costs, especially for patients who undergo spinal surgery. This study compared return-to-work rates after single-level cervical fusion for degenerative disk disease between patients who received opioids before surgery and patients who underwent fusion with no previous opioid use. All study subjects qualified for workers' compensation benefits for injuries sustained at work between 1993 and 2011. The study population included 281 subjects who underwent single-level cervical fusion for degenerative disk disease with International Classification of Diseases, Ninth Revision, and Current Procedural Terminology code algorithms. The opioid group included 77 subjects who received opioids preoperatively. The control group included 204 subjects who had surgery with no previous opioid use. The primary outcome was meeting return-to-work criteria within 3 years of follow-up after fusion. Secondary outcome measures after surgery, surgical details, and presurgical characteristics for each cohort also were collected. In 36.4% of the opioid group, return-to-work criteria were met compared with 56.4% of the control group. Patients who took opioids were less likely to meet return-to-work criteria compared with the control group (odds ratio, 0.44; 95% confidence interval, 0.26-0.76; P=.0028). Return-to-work rates within the first year after fusion were 24.7% for the opioid group and 45.6% for the control group (P=.0014). Patients who used opioids were absent from work for 255 more days compared with the control group (P=.0001). The use of opioids for management of diskogenic neck pain, with the possibility of surgical intervention, is a negative predictor of successful return to work after fusion in a workers' compensation population. [Orthopedics. 2017; 40(1):25-32.].
在有工伤赔偿申请的患者中使用阿片类药物会产生巨大成本，尤其是对于接受脊柱手术的患者。本研究比较了术前使用阿片类药物的患者与既往未使用过阿片类药物而接受融合手术的患者在因退行性椎间盘疾病行单节段颈椎融合术后的重返工作岗位率。所有研究对象均符合1993年至2011年期间因工作受伤而获得工伤赔偿福利的条件。研究人群包括281名根据国际疾病分类第九版和当前手术操作术语编码算法因退行性椎间盘疾病行单节段颈椎融合术的受试者。阿片类药物组包括77名术前使用阿片类药物的受试者。对照组包括204名既往未使用过阿片类药物而接受手术的受试者。主要结局是融合术后3年随访内达到重返工作岗位标准。还收集了每个队列术后的次要结局指标、手术细节和术前特征。阿片类药物组中有36.4%达到重返工作岗位标准，而对照组为56.4%。与对照组相比，服用阿片类药物的患者达到重返工作岗位标准的可能性较小（优势比，0.44；95%置信区间，0.26 - 0.76；P = 0.0028）。融合术后第一年的重返工作岗位率，阿片类药物组为24.7%，对照组为45.6%（P = 0.0014）。与对照组相比，使用阿片类药物的患者缺勤天数多255天（P = 0.0001）。在工伤赔偿人群中，使用阿片类药物治疗椎间盘源性颈部疼痛且有可能进行手术干预，是融合术后成功重返工作岗位失败的一个负性预测因素。[《骨科》。2017；40(1):25 - 32。]
