工人赔偿背景下，退行性腰椎狭窄症患者的术前阿片类药物治疗延长。
Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting.
机构信息
Case Western Reserve University School of Medicine, Cleveland, OH.
Department of Orthopedics, University Hospitals Case Medical Center, Cleveland, OH.
出版信息
Spine (Phila Pa 1976). 2017 Oct 1;42(19):E1140-E1146. doi: 10.1097/BRS.0000000000002112.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To investigate the impact of prolonged opioid use in the preoperative treatment plan of degenerative lumbar stenosis (DLS).
SUMMARY OF BACKGROUND DATA
Patients undergoing operative treatment for DLS with concomitant opioid use represent a clinically challenging population. The relative paucity of data on the relationship between preoperative opioid use and clinical outcomes in the workers' compensation (WC) population necessitates further study of this unique population.
METHODS
We identified 140 Ohio WC patients who underwent lumbar decompression and had received preoperative opioid prescriptions between 1993 and 2013. Our study cohorts were formed based on opioid use duration, which included short-term use (<3 months) and long-term use (>3 months). Our primary outcome was if patients were able to make a stable return to work (RTW). A multivariate regression analysis was used to determine the impact of the duration of preoperative opioid use on return to work rates. We also compared many secondary outcomes after surgery between both groups.
RESULTS
Patients on opioids less than 3 months had a significantly higher RTW rate compared with those who used opioids longer than 3 months [25/60 (42%) vs. 18/80 (23%); P = 0.01]. A logistic regression was performed to examine the effect of preoperative opioid therapy duration on RTW status. Our regression model showed that opioid use greater than 3 months remained a significant negative predictor of RTW (OR: 0.35, 95% CI: 0.13-0.89; P = 0.02). Patients who remained on opioid therapy longer than 3 months cost the Ohio Bureau of Workers' Compensation $70,979 more than patients who were on opioid therapy for less than 3 months (P < 0.01).
CONCLUSION
Prolonged preoperative opioid use was associated with poor clinical outcomes after lumbar decompression. These results suggest that a shorter course of opioid therapy and earlier surgical intervention may improve outcomes and lower postoperative morbidity in patients with DLS.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
研究退行性腰椎狭窄症（DLS）术前治疗计划中延长使用阿片类药物的影响。
背景资料概要
在接受手术治疗 DLS 且同时使用阿片类药物的患者代表了一个具有临床挑战性的人群。在工人补偿（WC）人群中，关于术前使用阿片类药物与临床结果之间关系的相对缺乏数据，需要进一步研究这一独特人群。
方法
我们确定了 140 名在俄亥俄州接受 WC 治疗的患者，他们在 1993 年至 2013 年间接受了腰椎减压术，并接受了术前阿片类药物处方。我们的研究队列是根据阿片类药物使用时间形成的，包括短期使用（<3 个月）和长期使用（>3 个月）。我们的主要结果是患者是否能够稳定地重返工作岗位（RTW）。使用多元回归分析来确定术前阿片类药物使用时间对重返工作岗位率的影响。我们还比较了两组手术后的许多次要结果。
结果
使用阿片类药物少于 3 个月的患者的 RTW 率明显高于使用阿片类药物超过 3 个月的患者[25/60（42%）与 18/80（23%）；P=0.01]。进行逻辑回归以检查术前阿片类药物治疗持续时间对 RTW 状态的影响。我们的回归模型表明，阿片类药物使用超过 3 个月仍然是 RTW 的显著负预测因子（OR：0.35，95%CI：0.13-0.89；P=0.02）。使用阿片类药物超过 3 个月的患者比使用阿片类药物少于 3 个月的患者给俄亥俄州工人补偿局带来的费用高出 70979 美元（P<0.01）。
结论
术前延长使用阿片类药物与腰椎减压术后临床结果不佳相关。这些结果表明，缩短阿片类药物治疗时间和更早的手术干预可能会改善 DLS 患者的结果并降低术后发病率。
证据水平
3 级。
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