Neck Pain, Preoperative Opioids, and Functionality After Cervical Fusion
Neck Pain, Preoperative Opioids, and Functionality After Cervical Fusion
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DOI：
10.3928/01477447-20161013-02
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发表时间：
2017-01-01
期刊：
影响因子：
1.1
通讯作者：
Ahn, Nicholas U.
中科院分区：
文献类型：
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作者：
Faour, Mhamad;Anderson, Joshua T.;Ahn, Nicholas U.
在提出工人赔偿要求的患者中使用阿片类药物与巨大的成本有关，特别是对接受脊柱手术的患者。这项研究比较了手术前接受阿片类药物治疗的退行性腰椎间盘疾病患者和接受融合手术但以前没有使用阿片类药物的患者之间的单节段颈椎融合术后的复工率。所有研究对象都有资格获得1993至2011年间因工受伤而获得的工人补偿福利。研究人群包括281名受试者，他们接受了单节段颈椎融合术治疗退行性腰椎间盘疾病，符合国际疾病分类第九版和当前程序术语编码算法。阿片组包括77名术前接受阿片类药物治疗的受试者。对照组包括204名手术前没有使用阿片类药物的受试者。主要结果是融合术后3年内达到重返工作的标准。还收集了手术后的次要结果、手术细节和每个队列的术前特征。在阿片组中，36.4%的人达到了重返工作的标准，而对照组的这一比例为56.4%。与对照组相比，服用阿片类药物的患者满足重返工作标准的可能性较小(优势比，0.44；95%可信区间，0.26-0.76；P=.0028)。阿片类药物组和对照组在融合后一年内的复工率分别为24.7%和45.6%(P=0.0014)。使用阿片类药物的患者缺勤天数比对照组多255天(P=0.0001)。在工人补偿人群中，使用阿片类药物治疗椎间盘源性颈部疼痛，并有可能进行手术干预，是融合后成功重返工作岗位的负面预测因素。
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.