title: Prolonged Preoperative Opioid Therapy Associated With Poor Return to Work Rates After Single-Level Cervical Fusion for Radiculopathy for Patients Receiving Workers' Compensation Benefits.
abstract: METHODS
  Retrospective comparative cohort study.
  
  
  OBJECTIVE
  Examine the effect of prolonged preoperative opioid use on return to work (RTW) status after single-level cervical fusion for radiculopathy.
  
  
  BACKGROUND
  The use of opioids has a dramatic effect in a workers' compensation population. The costs of claims that involved opioids in the management plan are catastrophic particularly for those undergoing spinal surgical procedure.
  
  
  METHODS
  Data of patients who underwent single-level cervical fusion for radiculopathy and had received opioid prescriptions before surgery were retrospectively collected from Ohio Bureau of Workers' Compensation between 1993 and 2011 after work-related injury. Then, based on opioid use duration, short-term use (STO) group (<3 mo), intermediate-term use (ITO) group (3-6 mo), and long-term use (LTO) group (>6 mo) were constructed. A multivariate logistic regression analysis was used to determine whether successful RTW status was achieved. Chi-square and analysis of variance tests were used to compare other secondary outcomes after surgery.
  
  
  RESULTS
  Prolonged preoperative opioid use was a negative predictor of successful RTW status (odds ratio = 0.73; 95% confidence interval: 0.55-0.98; P value: 0.04). Prolonged preoperative opioid use was associated with increasingly lower rates of achieving stable RTW status (P < 0.05) and RTW within 1 year after surgery (P < 0.05). The odds of achieving successful RTW status were 0.49 (0.25-0.94) for ITO, and 0.40 (0.24-0.68) for LTO compared with STO group. The odds of RTW less than 1 year after surgery were 0.43 (0.21-0.88) for ITO and 0.36 (0.21-0.62) for LTO compared with STO group. Prolonged preoperative opioid use was also associated with increasingly higher net medical costs (P < 0.01), and disability benefits awarded after surgery (P < 0.01).
  
  
  CONCLUSIONS
  Prolonged preoperative opioid use was associated with poor functional outcomes after cervical fusion. STO and earlier inclusion of the surgical approach in the management plan may offer better surgical and functional outcomes after cervical fusion.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopedics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Mhamad
authors.initials: M
authors.lastname: Faour
authors.affiliation: Department of Orthopedics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Anderson
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Arnold R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Rick
authors.initials: R
authors.lastname: Percy
authors.affiliation: Ohio Bureau of Workers' Compensation, Columbus, OH.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Woods
authors.affiliation: New Hampshire NeuroSpine Institute, Bedford, NH.
authors.forename: Uri M
authors.initials: UM
authors.lastname: Ahn
authors.affiliation: Department of Orthopedics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Nicholas U
authors.initials: NU
authors.lastname: Ahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000188:drug therapy*; D012189:Retrospective Studies; D062707:Return to Work; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods; D013997:Time Factors; D014942:Workers' Compensation / Q000191:economics*
chemical_list: D000701:Analgesics, Opioid