术前阿片类药物使用是腰椎间盘切除术后工人赔偿患者术后重返工作岗位不良的预测因素。
Preoperative Opioid Use is a Predictor of Poor Return to Work in Workers' Compensation Patients After Lumbar Diskectomy.
机构信息
University Hospitals Cleveland Medical Center Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH.
University of Utah Department of Orthopedics, Salt Lake City, Utah.
出版信息
Spine (Phila Pa 1976). 2018 Apr 15;43(8):594-602. doi: 10.1097/BRS.0000000000002385.
STUDY DESIGN
A retrospective cohort.
OBJECTIVE
The aim of this study was to determine the impact of preoperative opioid use in workers' compensation (WC) patients undergoing lumbar diskectomy (LD).
SUMMARY OF BACKGROUND DATA
The prevalence of back pain among opioid users approached 60%. Long-term opioid dependence in spine surgery patients is roughly 20%. Despite pervasive use, there is no evidence to support long-term opioid analgesic use for back pain.
METHODS
Ten thousand five hundred ninety-two patients received compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with spine comorbidities, smoking history, or multilevel surgery were excluded. Preoperatively, 566 patients had no opioid use, 126 had short-term opioid use (STO), 315 had moderate opioid use (MTO), and 279 had long-term opioid use (LTO). The primary outcome was whether subjects returned to work (RTW).
RESULTS
Seven hundred twelve (55.4%) patients met our RTW criteria. There was a significant difference in RTW rates among the no opioid (64.1%), MTO (52.7%), and LTO (36.9%) populations. Multivariate logistic regression analysis found several covariates to be independent negative predictors of RTW status: preoperative opioid use [P < 0.01; odds ratio (OR) = 0.54], time to surgery (P < 0.01; OR = 0.98 per month), legal representation (P < 0.01; OR = 0.57), and psychiatric comorbidity (P = 0.02; OR = 0.36). Patients in the LTO group had higher medical costs (P < 0.01), rates of psychiatric comorbidity (P < 0.01), incidence of failed back surgery syndrome (FBSS) (P < 0.01), and postoperative opioid use (P < 0.01) compared with the STO and no opioid groups.
CONCLUSION
Preoperative opioid use was determined to be a negative predictor of RTW rates after LD in WC patients. In addition, long-term preoperative opioid use was associated with higher medical costs, psychiatric illness, FBSS, and postoperative opioid use. Even a short or moderate course of preoperative opioids was associated with worse outcomes compared with no use. For WC patients undergoing LD, judicious use of preoperative opioid analgesics may improve clinical outcomes and reduce the opioid burden.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究旨在确定腰椎间盘切除术（LD）前接受过工人赔偿（WC）治疗的阿片类药物使用者的术前阿片类药物使用对其的影响。
背景资料概要
阿片类药物使用者的背痛患病率接近 60%。脊柱手术患者的长期阿片类药物依赖率约为 20%。尽管阿片类药物广泛使用，但没有证据支持长期使用阿片类药物治疗背痛。
方法
2005 年至 2012 年间，有 1592 名患者从俄亥俄州工人赔偿局获得赔偿，用于治疗腰椎间盘突出症。排除有脊柱合并症、吸烟史或多节段手术的患者。术前，566 名患者未使用阿片类药物，126 名患者短期使用阿片类药物（STO），315 名患者中度使用阿片类药物（MTO），279 名患者长期使用阿片类药物（LTO）。主要结果是患者是否恢复工作（RTW）。
结果
712 名（55.4%）患者符合我们的 RTW 标准。无阿片类药物（64.1%）、MTO（52.7%）和 LTO（36.9%）人群的 RTW 率存在显著差异。多变量逻辑回归分析发现，术前阿片类药物使用（P<0.01；优势比[OR] = 0.54）、手术时间（P<0.01；OR = 每月 0.98）、法律代表（P<0.01；OR = 0.57）和精神合并症（P=0.02；OR=0.36）是 RTW 状态的独立负预测因素。LTO 组患者的医疗费用更高（P<0.01）、精神合并症发生率更高（P<0.01）、失败的腰椎手术综合征（FBSS）发生率更高（P<0.01）、术后阿片类药物使用发生率更高（P<0.01）与 STO 和无阿片类药物组相比。
结论
术前阿片类药物使用被确定为 WC 患者 LD 后 RTW 率的负预测因素。此外，长期术前阿片类药物使用与更高的医疗费用、精神疾病、FBSS 和术后阿片类药物使用相关。与不使用相比，即使短期或中度使用术前阿片类药物也会导致更差的结果。对于接受 LD 的 WC 患者，谨慎使用术前阿片类药物镇痛可能会改善临床结果并减轻阿片类药物负担。
证据水平
3 级。
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