Faour Mhamad, Anderson Joshua T, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Department of Orthopaedics, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland.
Ohio Bureau of Workers' Compensation, Columbus, OH.
Clin Spine Surg. 2018 Feb;31(1):E19-E24. doi: 10.1097/BSD.0000000000000545.
Retrospective comparative case-control study.
The objectives of this study are: (1) How preoperative opioid use impacts RTW status after single-level cervical fusion for radiculopathy? and (2) What are other postsurgical outcomes affected by preoperative opioid use?
Opioid use has increased significantly in the past decade. The use of opioids has a drastic impact on workers' compensation population, an at-risk cohort for poorer surgical and functional outcomes than the general population.
Data was retrospectively collected from Ohio Bureau of Workers' Compensation between 1993 and 2011. The study population included patients who underwent single-level cervical fusion for radiculopathy as identified by current procedural terminology codes and International Classification of Diseases-9 codes. On the basis of opioid use before surgery, two groups were constructed (opioids vs. non-opioids). Using a multivariate logistic regression model, the effect of preoperative opioid use on return to work (RTW) status after fusion was analyzed and compared between the groups.
In the regression model, preoperative opioid use was a negative predictor of RTW status within 3-year follow-up after surgery. Opioid patients were less likely to have stable RTW status [odds ratio (OR), 0.50; 95% confidence interval (CI), 0.38-0.65; P=0.05] and were less likely to RTW within the first year after surgery (OR, 0.50; 95% CI, 0.37-0.66; P=0.05) compared with controls. Stable RTW was achieved in 43.3% of the opioids group and 66.6% of control group (P=0.05). RTW rate within the first year after fusion was 32.5% of opioids group and 57% of control group (P<0.05).Reoperation and permanent disability rates after surgery were higher in the opioid group compared with the control group (P<0.05).
In a workers' compensation, patients with work-related injury who underwent single-level cervical fusion for radiculopathy and received opioids before surgery had worse RTW status, a higher reoperation rate, and higher rate of awarded permanent disability after surgery.
回顾性比较病例对照研究。
本研究的目的是：（1）术前使用阿片类药物如何影响神经根病单节段颈椎融合术后的恢复工作（RTW）状态？（2）术前使用阿片类药物还会影响哪些术后结果？
在过去十年中，阿片类药物的使用显著增加。阿片类药物的使用对工人赔偿人群有巨大影响，这是一个比普通人群手术和功能结果更差的高危队列。
回顾性收集了1993年至2011年俄亥俄州工人赔偿局的数据。研究人群包括根据当前手术术语代码和国际疾病分类第9版代码确定的因神经根病接受单节段颈椎融合术的患者。根据术前阿片类药物的使用情况，构建了两组（阿片类药物组与非阿片类药物组）。使用多变量逻辑回归模型，分析并比较两组术前使用阿片类药物对融合术后恢复工作（RTW）状态的影响。
在回归模型中，术前使用阿片类药物是术后3年随访内RTW状态的负预测因子。与对照组相比，阿片类药物组患者恢复稳定RTW状态的可能性较小[比值比（OR），0.50；95%置信区间（CI），0.38 - 0.65；P = 0.05]，且术后第一年恢复工作的可能性较小（OR，0.50；95% CI，0.37 - 0.66；P = 0.05）。阿片类药物组43.3%的患者实现了稳定RTW，对照组为66.6%（P = 0.05）。融合术后第一年的RTW率在阿片类药物组为32.5%，对照组为57%（P < 0.05）。与对照组相比，阿片类药物组术后再次手术和永久性残疾率更高（P < 0.05）。
在工人赔偿中，因神经根病接受单节段颈椎融合术且术前接受阿片类药物治疗的工伤患者，其RTW状态较差，再次手术率较高，术后获得永久性残疾的比率也较高。
