title: Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To investigate the impact of prolonged opioid use in the preoperative treatment plan of degenerative lumbar stenosis (DLS).
  
  
  BACKGROUND
  Patients undergoing operative treatment for DLS with concomitant opioid use represent a clinically challenging population. The relative paucity of data on the relationship between preoperative opioid use and clinical outcomes in the workers' compensation (WC) population necessitates further study of this unique population.
  
  
  METHODS
  We identified 140 Ohio WC patients who underwent lumbar decompression and had received preoperative opioid prescriptions between 1993 and 2013. Our study cohorts were formed based on opioid use duration, which included short-term use (<3 months) and long-term use (>3 months). Our primary outcome was if patients were able to make a stable return to work (RTW). A multivariate regression analysis was used to determine the impact of the duration of preoperative opioid use on return to work rates. We also compared many secondary outcomes after surgery between both groups.
  
  
  RESULTS
  Patients on opioids less than 3 months had a significantly higher RTW rate compared with those who used opioids longer than 3 months [25/60 (42%) vs. 18/80 (23%); P = 0.01]. A logistic regression was performed to examine the effect of preoperative opioid therapy duration on RTW status. Our regression model showed that opioid use greater than 3 months remained a significant negative predictor of RTW (OR: 0.35, 95% CI: 0.13-0.89; P = 0.02). Patients who remained on opioid therapy longer than 3 months cost the Ohio Bureau of Workers' Compensation $70,979 more than patients who were on opioid therapy for less than 3 months (P < 0.01).
  
  
  CONCLUSIONS
  Prolonged preoperative opioid use was associated with poor clinical outcomes after lumbar decompression. These results suggest that a shorter course of opioid therapy and earlier surgical intervention may improve outcomes and lower postoperative morbidity in patients with DLS.
  
  
  METHODS
  3.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH.|Department of Orthopedics, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Erik Y
authors.initials: EY
authors.lastname: Tye
authors.affiliation: Department of Orthopedics, University of Utah, Salt Lake City, UT.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Anderson
authors.affiliation: Department of Orthopedics, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Mhamad
authors.initials: M
authors.lastname: Faour
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, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Nicholas U
authors.initials: NU
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods / Q000639:trends; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000009:adverse effects* / Q000639:trends*; D012189:Retrospective Studies; D062707:Return to Work / Q000639:trends; D013123:Spinal Fusion / Q000379:methods / Q000639:trends; D014942:Workers' Compensation / Q000639:trends*
chemical_list: D000701:Analgesics, Opioid