Chronic Opioid Therapy After Lumbar Fusion Surgery for Degenerative Disc Disease in a Workers' Compensation Setting
Chronic Opioid Therapy After Lumbar Fusion Surgery for Degenerative Disc Disease in a Workers' Compensation Setting
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DOI：
10.1097/brs.0000000000001054
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发表时间：
2015-11-01
期刊：
影响因子：
3
通讯作者：
Ahn, Nicholas U.
中科院分区：
文献类型：
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作者：
Anderson, Joshua T.;Haas, Arnold R.;Ahn, Nicholas U.
研究设计。回顾性队列研究。目的：评估处方阿片类药物的使用后腰椎融合退行性椎间盘疾病的工人补偿（WC）设置。背景资料摘要。使用阿片类药物治疗慢性腰痛已大大增加。很少有研究评估慢性阿片类药物治疗（COT）在临床不同的WC人群中的危险因素。我们使用“现行程序术语”和“国际疾病分类，第九次修订”代码来识别1993年至2013年期间因退行性椎间盘疾病行腰椎融合术的1002名俄亥俄州WC受试者。术后COT定义为融合术后6周急性期后给予阿片类镇痛药超过1年。575名受试者符合这些标准，组成COT组。其余427名受试者组成临时阿片类药物组。为了确定与融合后COT相关的预后因素，我们使用了多因素logistic回归分析。重返工作岗位与COT呈负相关（P < 0.001；比值比[OR] 0.38）。融合前COT （P < 0.001; OR 6.15）、背部衰竭综合征（P < 0.001; OR 3.40）、额外手术（P < 0.001; OR 2.84）、临床诊断的抑郁症（P < 0.001; OR 2.34）和融合前延长的工作损失（P = 0.038; OR 1.61）与COT呈正相关。与这些因素相关的术后COT发生率分别为27.8%、79.6%、85.0%、76.4%、77.1%和61.3%。术前较高的阿片类药物负荷（P < 0.001）和使用时间（P < 0.001）与术后较高的COT发生率呈正相关。融合后3年内，COT组平均阿片类药物使用1083.4天，阿片类药物处方49.0张，其中附表II占86.2%。COT组复工率为11.0%，人均医疗费用高出27,952美元，精神合并症发生率为43.5%，背部综合症发生率为16.7%，额外腰椎手术发生率为27.7%。大多数研究人群在融合后进行COT。COT与较差的预后相关。这项研究的不良结果可能表明椎间盘融合在WC患者中的作用更有限。
Study Design. Retrospective cohort study.Objective. To evaluate prescription opioid use after lumbar fusion for degenerative disc disease in a workers' compensation (WC) setting.Summary of Background Data. Use of opioids for treating chronic low back pain has increased greatly. Few studies have evaluated risk factors for chronic opioid therapy (COT) among the clinically-distinct WC population.Methods. We used "Current Procedural Terminology'' and "International Classification of Diseases, Ninth Revision'' codes to identify 1002 Ohio WC subjects who underwent lumbar fusion for degenerative disc disease from 1993 to 2013. Postoperative COT was defined as being supplied with opioid analgesics for greater than 1 year after the 6-week acute period after fusion. 575 subjects fit these criteria, forming the COT group. The remaining 427 subjects formed a temporary opioid group. To identify prognostic factors associated with COT after fusion, we used a multivariate logistic regression analysis.Results. Returning to work was negatively associated with COT (P < 0.001; odds ratio [OR] 0.38). COT before fusion (P < 0.001; OR 6.15), failed back syndrome (P < 0.001; OR 3.40), additional surgery (P < 0.001; OR 2.84), clinically diagnosed depression (P < 0.001; OR 2.34), and extended work loss before fusion (P = 0.038; OR 1.61) were positively associated with COT. The rates of postoperative COT associated with these factors were 27.8%, 79.6%, 85.0%, 76.4%, 77.1%, and 61.3%, respectively. Higher preoperative opioid load (P < 0.001) and duration of use (P < 0.001) were positively associated with higher postoperative rates of COT. Within 3 years after fusion, the COT group was supplied with an average of 1083.4 days of opioids and 49.0 opioid prescriptions, 86.2% of which were Schedule II. The COT group had an 11.0% return to work rate, $27,952 higher medical costs per subject, 43.5% rate of psychiatric comorbidity, 16.7% rate of failed back syndrome, and 27.7% rate of additional lumbar surgery.Conclusion. The majority of the study population was on COT after fusion. COT was associated with considerably worse outcomes. The poor outcomes of this study could suggest a more limited role for discogenic fusion among WC patients.