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Tefera YG, Gray S, Nielsen S, Gelaw A, Collie A. Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:398-414. [PMID: 37934329 PMCID: PMC11180015 DOI: 10.1007/s10926-023-10138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes. METHODS We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible. RESULTS From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes. CONCLUSION Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.
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Affiliation(s)
- Yonas Getaye Tefera
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Australia
| | - Asmare Gelaw
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Tefera YG, Gray S, Nielsen S, Collie A. Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis. Int J Surg 2024; 110:1781-1792. [PMID: 38181114 PMCID: PMC10942173 DOI: 10.1097/js9.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). OBJECTIVE This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. MATERIAL AND METHODS The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. RESULTS From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). CONCLUSIONS This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.
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Affiliation(s)
- Yonas G. Tefera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Luo M, Shi F, Wang H, Chen Z, Dai H, Shi Y, Chen J, Tang S, Huang J, Xiao Z. The impact of perioperative opioid use on postoperative outcomes following spinal surgery: a meta-analysis of 60 cohort studies with 13 million participants. Spine J 2024; 24:278-296. [PMID: 37844626 DOI: 10.1016/j.spinee.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/01/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND CONTEXT An important factor for the prognosis of spinal surgery is the perioperative use of opioids. However, the relationship is not clear. PURPOSE The purpose of this study was to evaluate the effect of perioperative opioid use on the prognosis of patients following spinal surgery. STUDY DESIGN/SETTING Systematic review and meta-analysis. OUTCOME MEASURES A meta-analysis was conducted using the random-effects method to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). METHODS The PubMed, Embase, and Cochrane Library databases were systematically searched to find relevant articles that were published until September 2, 2022. The primary outcome was prolonged postoperative opioid use, and secondary outcomes included the length of stay (LOS), reoperation, the time to return to work (RTW), postoperative complications, gastrointestinal complications, new permanent disability, central nervous system events and infection. In addition, subgroup analysis of the primary outcome was conducted to explore the main sources of heterogeneity, and sensitivity analysis of all outcomes was performed to evaluate the stability of the results. RESULTS A total of 60 cohort studies involving 13,219,228 individuals met the inclusion criteria. Meta-analysis showed that perioperative opioid use was specifically related to prolonged postoperative opioid use (OR 6.91, 95% CI 6.09 to 7.84, p<.01). Furthermore, the results also showed that perioperative opioid use was significantly associated with prolonged LOS (OR 1.74, 95% CI 1.39 to 2.18, p<.01), postoperative complications (OR 1.72, 95% CI 1.26 to 2.36, p<.01), reoperation (OR 2.38, 95% CI 1.85 to 3.07, p<.01), the time to RTW (OR 0.45, 95% CI 0.39 to 0.52, p<.01), gastrointestinal complications (OR 1.39, 95% CI 1.30 to 1.48, p<.01), central nervous system events (OR 1.99, 95% CI 1.21 to 3.27, p=.07) and infection (OR 1.22, 95% CI 1.09 to 1.36, p=.01). These results were corroborated by the trim-and-fill procedure and leave-one-out sensitivity analyses. CONCLUSIONS Based on the current evidence, patients with perioperative opioid use, in comparison to controls, appear to have prolonged postoperative opioid use, which may increase the risk of poor outcomes including prolonged LOS, complications, reoperation, RTW and so on. However, these results must be carefully interpreted as the number of studies included was small and the studies were statistically heterogeneous. These findings may help clinicians to realize the harmfulness of perioperative use of opioids, reduce the use of prescription opioids, necessarily withdraw before operation or significantly wean to the lowest tolerable preoperative amount, and provide some inspiration for standardizing the use of opioids in the future.
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Affiliation(s)
- Mingjiang Luo
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Fuwen Shi
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China; Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Hongxu Wang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zuoxuan Chen
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Huijie Dai
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi 830054, China
| | - Jiang Chen
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Siliang Tang
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Jingshan Huang
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Zhihong Xiao
- Department of spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China.
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Fortier L, Sinkler MA, De Witt AJ, Wenger DM, Imani F, Morsali SF, Urits I, Viswanath O, Kaye AD. The Effects of Opioid Dependency Use on Postoperative Spinal Surgery Outcomes: A Review of the Available Literature. Anesth Pain Med 2023; 13:e136563. [PMID: 38024004 PMCID: PMC10676665 DOI: 10.5812/aapm-136563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 12/01/2023] Open
Abstract
There is a lack of evidence to support the effectiveness of long-term opioid therapy in patients with chronic, noncancer pain. Despite these findings, opioids continue to be the most commonly prescribed drug to treat chronic back pain and many patients undergoing spinal surgery have trialed opioids before surgery for conservative pain management. Unfortunately, preoperative opioid use has been shown repeatedly in the literature to negatively affect spinal surgery outcomes. In this review article, we identify and summarize the main postoperative associations with preoperative opioid use that have been found in previously published studies by searching on PubMed, Google Scholar, Medline, and ScienceDirect; using keywords: Opioid dependency, postoperative, spinal surgery, specifically (1) increased postoperative chronic opioid use (24 studies); (2) decreased return to work (RTW) rates (8 studies); (3) increased length of hospital stay (LOS) (9 studies); and (4) increased healthcare costs (8 studies). The conclusions from these studies highlight the importance of recognizing patients on opioids preoperatively to effectively risk stratify and identify those who will benefit most from multidisciplinary counseling and guidance.
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Affiliation(s)
- Luc Fortier
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret A. Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Audrey J. De Witt
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | | | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fatemeh Morsali
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
| | - Alan D. Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA
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Hartman TJ, Nie JW, Zheng E, MacGregor KR, Oyetayo OO, Federico VP, Massel DH, Sayari AJ, Singh K. Influence of Prolonged Duration of Symptoms Before MIS-TLIF in a Workers' Compensation Population. World Neurosurg 2023; 175:e439-e446. [PMID: 37024079 DOI: 10.1016/j.wneu.2023.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE We assessed the potential effect of the preoperative symptom duration on patient-reported outcomes (PROs) for workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS WC patients who had undergone primary, elective MIS-TLIF with recorded symptoms duration data available were included. Two cohorts were generated: those with a shorter (lesser) duration (LD; symptom duration <1 year) and those with a prolonged duration (PD; symptom duration >1 year). PROs were collected preoperatively and at several follow-up points for ≤1 year postoperatively. The PROs were compared within and between the 2 cohorts. The achievement rates of minimum clinically important differences were also compared between the 2 cohorts. RESULTS A total of 145 patients were included, with 76 in the PD cohort and 69 in the LD cohort. The LD cohort demonstrated improvement in the patient-reported outcomes measurement information system for physical function (PROMIS-PF) at 6 months and 1 year postoperatively, Oswestry disability index (ODI) at 12 weeks and 6 months postoperatively, visual analog scale (VAS) score for back pain at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for leg pain at all postoperative points (P ≤ 0.015 for all). The PD cohort demonstrated improvement in the PROMIS-PF at 12 weeks and 6 months postoperatively, ODI at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for back pain and leg pain at all postoperative periods (P ≤ 0.007 for all). All the preoperative PROs were superior for the LD cohort (P < 0.001 for all). The LD cohort reported better PROMIS-PF at 6 months and 1 year and ODI at 1 year postoperatively (P ≤ 0.037 for all). The PD cohort was more likely to achieve a minimum clinically important difference in ODI at 6 and 12 weeks postoperatively, VAS score for back pain at 6 weeks postoperatively, and VAS score for leg pain at 6 weeks and 1 year postoperatively and overall (P ≤ 0.036 for all). CONCLUSIONS Independently of the preoperative symptom duration, WC patients demonstrated improvement in physical function and pain after MIS-TLIF. Patients with a longer symptom duration reported inferior function and pain preoperatively and were more likely to demonstrate clinically significant improvements in disability and pain postoperatively.
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Affiliation(s)
- Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Evaluation of Factors Affecting Return to Work Following Carpal Tunnel Release: A Statewide Cohort Study of Workers' Compensation Subjects. J Hand Surg Am 2022; 47:544-553. [PMID: 35484044 DOI: 10.1016/j.jhsa.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/07/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Most randomized trials comparing open carpal tunnel release (OCTR) to endoscopic carpal tunnel release (ECTR) are not specific to a working population and focus mainly on how surgical technique has an impact on outcomes. This study's primary goal was to evaluate factors affecting days out of work (DOOW) following carpal tunnel release (CTR) in a working population and to evaluate for differences in medical costs, indemnity payments, disability ratings, and opioid use between OCTR and ECTR with the intent of determining whether one or the other surgical method was a determining factor. METHODS Using the Ohio Bureau of Workers' Compensation claims database, individuals were identified who underwent unilateral isolated CTR between 1993 and 2018. We excluded those who were on total disability, who underwent additional surgery within 6 months of their index CTR, including contralateral or revision CTR, and those not working during the same month as their index CTR. Outcomes were evaluated at 6 months after surgery. Multivariable linear regression was performed to evaluate covariates associated with DOOW. RESULTS Of the 4596 included participants, 569 (12.4%) and 4027 (87.6%) underwent ECTR and OCTR, respectively. Mean DOOW were 58.4 for participants undergoing OCTR and 56.6 for those undergoing ECTR. Carpal tunnel release technique was not predictive of DOOW. Net medical costs were 20.7% higher for those undergoing ECTR. Multivariable linear regression demonstrated the following significant predictors of higher DOOW: preoperative opioid use, legal representation, labor-intensive occupation, increasing lag time from injury to filing of a worker's compensation claim, and female sex. Being married, higher income community, and working in the public sector were associated with fewer DOOW. CONCLUSIONS In a large statewide worker's compensation population, demographic, occupational, psychosocial, and litigatory factors have a significant impact on DOOW following CTR, whereas differences in surgical technique between ECTR and OCTR did not. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Patel MR, Jacob KC, Prabhu MC, Vanjani NN, Pawlowski H, Amin K, Singh K. Obesity and Workers' Compensation in the Setting of Minimally Invasive Lumbar Decompression. World Neurosurg 2022; 164:e341-e348. [PMID: 35490892 DOI: 10.1016/j.wneu.2022.04.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the influence of body mass index (BMI) on perioperative outcomes, postoperative patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement among workers' compensation (WC) claimants undergoing minimally invasive lumbar decompression (MIS-LD). METHODS WC patients diagnosed with herniated nucleus pulposus undergoing single-level MIS-LD were identified. Patients were divided into 3 groups: Non-obese (<30 kg/m2), Obese I (≥30 and <35 kg/m2), and Obese II/III (≥35 kg/m2). PROMs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively. The predictive influence of BMI grouping on mean PROM scores was computed using simple linear regression. To compare PROMs between groups, post hoc pairwise comparisons of adjusted means were utilized. MCID achievement was compared between groups with χ2 analysis. RESULTS A total of 81 patients were in the Non-obese cohort, and 43 and 45 in the Obese I and Obese II/III cohorts, respectively. Visual analog scale (VAS) leg, Oswestry Disability Index (ODI), and 12-Item Short Form Physical Composite Score (SF-12 PCS) were worse in the Obese I cohort at 12 weeks, and SF-12 PCS was lower in the Obese I vs. Obese II/III subgroup analysis (P ≤ 0.045, all). MCID achievement rates for ODI were higher for the Non-obese group at 12 weeks and overall (P ≤ 0.049, both). MCID attainment for VAS back was higher among the Non-obese cohort at 6-weeks (P = 0.022). CONCLUSIONS Patients with higher levels of obesity were more likely to experience longer length of stay and delayed discharge following MIS-LD. Increasing BMI was generally not a significant predictor of postoperative pain, disability, or physical health PROMs at most timepoints. MCID achievement rates for disability relief were significantly higher for non-obese patients.
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Affiliation(s)
- Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kanhai Amin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Impact of Time to Surgery for Workers' Compensation Patients Undergoing MIS TLIF: A Preliminary Analysis on Clinical Outcomes. World Neurosurg 2022; 160:e421-e429. [PMID: 35033696 DOI: 10.1016/j.wneu.2022.01.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To conduct a preliminary analysis on the impact of time to surgery (TTS) and duration of symptoms (DOS) on clinical outcomes in workers' compensation patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS WC patients undergoing primary, single-level MIS TLIF were identified. PROMs were administered at preoperative/6-week/12-week/6-month postoperative timepoints and included VAS back/VAS leg/ODI/SF-12 PCS/SF-12 MCS. Patients were grouped by TTS: <90 days, 90-179 days, ≥180 days. Demographics were compared by chi-squared; perioperative characteristics, mean PROMs, and postoperative improvement (ΔPROM) were compared using one way ANOVA. MCID achievement rates were compared using simple logistic regression. A secondary analysis was performed by grouping patients by DOS: <180 days, 180-364 days, ≥365 days. Mean PROMs, ΔPROMs, and MCID achievement were similarly compared between DOS groups using one way ANOVA and logistic regression. RESULTS 193 patients included. Prevalence of HNP and initial appointment type were significantly associated with TTS(p<0.042, all)(Tables 1 and 2). No significant differences in mean PROMs or ΔPROMs were observed among TTS groups(Tables 3 and 4). MCID achievement was significantly lower for VAS back at 6-months in longest TTS group(Table 4). Mean PROMs were significantly different based on DOS for VAS leg at 6-weeks only(Table 5). MCID achievement was significantly lower for longest DOS group for VAS leg at 6-months only. ΔPROMs did not significantly differ among DOS groups(Table 6). CONCLUSION Neither TTS nor DOS significantly associated with MIS TLIF outcomes. WC patients may achieve similar clinical improvement even with longer symptom burden and substantial delays in operative treatment.
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Vraa ML, Myers CA, Young JL, Rhon DI. More Than 1 in 3 Patients With Chronic Low Back Pain Continue to Use Opioids Long-term After Spinal Fusion: A Systematic Review. Clin J Pain 2021; 38:222-230. [PMID: 34856579 DOI: 10.1097/ajp.0000000000001006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A common expectation for patients after elective spine surgery is that the procedure will result in pain reduction and minimize the need for pain medication. Most studies report changes in pain and function after spine surgery, but few report the extent of opioid use after surgery. This systematic review aims to identify the rates of opioid use after lumbar spine fusion. MATERIALS AND METHODS PubMed, CINAHL, Cochrane Central Register of Controlled Trials, and Ovid Medline were searched to identify studies published between January 1, 2005 and June 30, 2020 that assessed the effectiveness of lumbar fusion for the management of low back pain. RESULTS Of 6872 abstracts initially identified, 329 studies met the final inclusion criteria, and only 32 (9.7%) reported any postoperative opioid use. Long-term opioid use after surgery persists for more than 1 in 3 patients with usage ranging from 6 to 85.9% and a pooled mean of 35.0% based on data from 21 studies (6.4% of all lumbar fusion studies). DISCUSSION Overall, opioid use is not reported in the majority of lumbar fusion trials. Patients may expect a reduced need for opioid-based pain management after surgery, but the limited data available suggests long-term use is common. Lack of consistent reporting of these outcomes limits definitive conclusions regarding the efficacy of spinal fusion for reducing long-term opioid. Patient decisions about undergoing surgery may be altered if they had realistic expectations about rates of postsurgical opioid use. Spine surgery trials should track opioid utilization out to a minimum of 6 months after surgery as a core outcome.
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Affiliation(s)
- Matthew L Vraa
- Doctorate of Science in Physical Therapy Program, Bellin College, Green Bay, WI
- Physical Therapy Program, Northwest University, Kirkland, WA
| | - Christina A Myers
- Doctorate of Science in Physical Therapy Program, Bellin College, Green Bay, WI
- Department of Physical Therapy, South College, Knoxville, TN
| | - Jodi L Young
- Doctorate of Science in Physical Therapy Program, Bellin College, Green Bay, WI
| | - Daniel I Rhon
- Doctorate of Science in Physical Therapy Program, Bellin College, Green Bay, WI
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
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Does Workers' Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116165. [PMID: 34200483 PMCID: PMC8201180 DOI: 10.3390/ijerph18116165] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/29/2022]
Abstract
Low back pain (LBP) is currently the leading cause of disability worldwide and the most common reason for workers’ compensation (WC) claims. Studies have demonstrated that receiving WC is associated with a negative prognosis following treatment for a vast range of health conditions. However, the impact of WC on outcomes after spine surgery is still controversial. The aim of this meta-analysis was to systematically review the literature and analyze the impact of compensation status on outcomes after lumbar spine surgery. A systematic search was performed on Medline, Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patients undergoing lumbar spine surgery in which compensation status was reported. Methodological quality was assessed through ROBINS-I and quality of evidence was estimated using the GRADE rating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patients had higher post-operative pain and disability, as well as lower satisfaction after surgery when compared to those without WC. Furthermore, WC patients demonstrated to have a delayed return to work. According to our results, compensation status is associated with poor outcomes after lumbar spine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helps understand the multifactorial nature of the phenomenon.
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11
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Anderson JT, Hudyk AR, Haas AR, Ahn NU, Rothberg DL, Gililland JM. Displaced Femoral Neck Fractures in Workers' Compensation Patients Aged 45-65 Years: Is It Best to Fix the Fracture or Replace the Joint? J Arthroplasty 2020; 35:3195-3203. [PMID: 32600808 DOI: 10.1016/j.arth.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Optimal surgical management of displaced femoral neck fractures (dFNFs) in subjects 45-65 years old is unclear. We evaluated days out of work (dOOW), medical and indemnity costs, and secondary outcomes at 2 years between internal fixation (IF), hemiarthroplasty (HA), and total hip arthroplasty (THA) among workers' compensation (WC) subjects with isolated dFNFs aged 45-65. METHODS We retrospectively identified 105 Ohio Bureau of WC subjects with isolated subcapital dFNFs aged 45-65 with 2 years of follow-up. In total, 37 (35.2%) underwent IF, 23 (21.9%) THA, and 45 (42.9%) HA from 1993 to 2017. Linear regression was used to determine if surgery type was predictive of dOOW postoperatively and to evaluate inflation-adjusted net medical and indemnity costs at 2 years. RESULTS IF subjects were younger (52.9) than THA (58.5, P < .001) and HA (58.4, P < .001) subjects. Mean dOOW for THA subjects at 6 months, 1 year, and 2 years was 90.8, 114.6, and 136.6. This was significantly lower than IF (136.3, 182.0, 236.6) and HA (114.6, 153.3, 247.6) subjects at all time points. Medical costs were similar. Mean indemnity costs were 3.0 and 2.4 times higher among IF (P < .001) and HA (P = .007) groups compared to THA, respectively. Rates of postoperative permanent disability awards were 13.0%, 43.2%, and 35.6% for the THA, IF, and HA groups (P = .050). IF and HA subjects had a 24.3% and 11.1% revision rate. Overall, 77.8% and 100% of the IF and HA revisions were conversions to THA. CONCLUSION WC subjects aged 45-65 with dFNFs treated with THA had fewer dOOW, lower indemnity costs, and less disability at 2 years. Longer follow-up will help determine the durability and long-term outcomes of these surgeries.
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Affiliation(s)
- Joshua T Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | | | | | - Nicholas U Ahn
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - David L Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
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12
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Reisener MJ, Hughes AP, Schadler P, Forman A, Sax OC, Shue J, Cammisa FP, Sama AA, Girardi FP, Mancuso CA. Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users. Asian Spine J 2020; 14:663-672. [PMID: 32810977 PMCID: PMC7595819 DOI: 10.31616/asj.2020.0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 01/19/2023] Open
Abstract
STUDY DESIGN Matched cohort study. PURPOSE To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids. OVERVIEW OF LITERATURE Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients' expectations of lumbar surgery outcomes remain to be rigorously assessed. METHODS A total of 77 opioid users grouped according to dose and duration (54 "higher users," 30 "lower users") were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. "Greater expectations" was defined as a higher survey score (possible range, 0-100) based on the number of items expected and degree of improvement expected. RESULTS The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, p=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, p=0.01) and compared with higher users (70, p=0.01). In multivariable analysis, "reater expectations" was independently associated with having had chiropractic care (p=0.03), being more disabled (p=0.002), and being a lower-dose opioid user (p=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, p=0.003). CONCLUSIONS Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.
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Affiliation(s)
| | - Alexander P. Hughes
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul Schadler
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Alexa Forman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Oliver C. Sax
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jennifer Shue
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank P. Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andrew A. Sama
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Federico P. Girardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carol A. Mancuso
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
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Lo YT, Lim-Watson M, Seo Y, Fluetsch N, Alasmari MM, Alsheikh MY, Lamba N, Smith TR, Aglio LS, Mekary RA. Long-Term Opioid Prescriptions After Spine Surgery: A Meta-Analysis of Prevalence and Risk Factors. World Neurosurg 2020; 141:e894-e920. [PMID: 32569762 DOI: 10.1016/j.wneu.2020.06.081] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Opioids are frequently prescribed for back pain, but the prevalence of and risk factors for long-term opioid use after spine surgery were not clearly reported. We conducted a systematic review and meta-analysis to summarize the evidence for long-term opioid use (>90 days) among adults who underwent spine surgery. METHODS PubMed, EMBASE, and Cochrane indexing databases were searched until November 9, 2018 for studies reporting the prevalence of and risk factors for long-term opioid use after spine surgery. Separate meta-analyses were conducted for commercial claims databases or registries (claims/registries) and nonclaims observational studies using the random-effects model to estimate the pooled odds ratio (OR). Prevalence meta-analysis was performed in a clinically homogeneous subset of these patients who underwent lumbar spine surgery. RESULTS Eight claims and 5 nonclaims were meta-analyzed to avoid double-counting participants. The meta-analysis showed that preoperative opioid users (OR, 5.59; 95% confidence interval [CI], 3.37-9.27 vs. OR 4.21; 95% CI, 2.72-6.51) and participants with preexisting depression and/or anxiety (OR, 1.86, 95% CI, 1.43-2.42 and OR, 1.20; 95% CI, 0.83-1.74, respectively) had a statistically significantly higher odds of long-term postoperative opioids, compared with their peers. Males showed lower odds of long-term postoperative opioid use in the claims group (OR, 0.85; 95% CI, 0.79-0.92), but not in the nonclaims group (OR, 0.99; 95% CI, 0.71-1.39). The pooled prevalence of post-lumbar spine surgery long-term opioid use was 63% (95% CI, 50%-74%) in claims and 47% (95% CI, 38%-56%) in nonclaims. CONCLUSIONS Patients undergoing spine surgery represent a high-risk surgical population requiring special attention and targeted interventions, with the strongest evidence for those treated with opioids before surgery and those with psychiatric comorbidities.
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Affiliation(s)
- Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, Singapore
| | | | - Yookyung Seo
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Noemi Fluetsch
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Moudi M Alasmari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mona Y Alsheikh
- Clinical Pharmacy Department, School of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Radiation Oncology Program, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Linda S Aglio
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; School of Pharmacy, MCPHS University, Boston, Massachusetts, USA.
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DiGiorgio AM, Mummaneni PV, Park P, Chan AK, Bisson EF, Bydon M, Foley KT, Glassman SD, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Wang MY, Fu KM, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Haid RW, Slotkin JR. Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the Quality Outcomes Database. Neurosurg Focus 2020; 48:E5. [DOI: 10.3171/2020.2.focus191022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEReturn to work (RTW) and satisfaction are important outcome measures after surgery for degenerative spine disease. The authors queried the prospective Quality Outcomes Database (QOD) to determine if RTW correlated with patient satisfaction.METHODSThe QOD was queried for patients undergoing surgery for degenerative lumbar spondylolisthesis. The primary outcome of interest was correlation between RTW and patient satisfaction, as measured by the North American Spine Society patient satisfaction index (NASS). Secondarily, data on satisfied patients were analyzed to see what patient factors correlated with RTW.RESULTSOf 608 total patients in the QOD spondylolisthesis data set, there were 292 patients for whom data were available on both satisfaction and RTW status. Of these, 249 (85.3%) were satisfied with surgery (NASS score 1–2), and 224 (76.7%) did RTW after surgery. Of the 68 patients who did not RTW after surgery, 49 (72.1%) were still satisfied with surgery. Of the 224 patients who did RTW, 24 (10.7%) were unsatisfied with surgery (NASS score 3–4). There were significantly more people who had an NASS score of 1 in the RTW group than in the non-RTW group (71.4% vs 42.6%, p < 0.05). Failure to RTW was associated with lower level of education, worse baseline back pain (measured with a numeric rating scale), and worse baseline disability (measured with the Oswestry Disability Index [ODI]).CONCLUSIONSThere are a substantial number of patients who are satisfied with surgery even though they did not RTW. Patients who were satisfied with surgery and did not RTW typically had worse preoperative back pain and ODI and typically did not have a college education. While RTW remains an important measure after surgery, physicians should be mindful that patients who do not RTW may still be satisfied with their outcome.
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Affiliation(s)
- Anthony M. DiGiorgio
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Praveen V. Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul Park
- 3Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew K. Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F. Bisson
- 4Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | - Mohamad Bydon
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin T. Foley
- 6Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Christopher I. Shaffrey
- 8Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Eric A. Potts
- 9Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E. Shaffrey
- 10Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Domagoj Coric
- 11Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Michael Y. Wang
- 13Department of Neurological Surgery, University of Miami, Florida
| | - Kai-Ming Fu
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | - Anthony L. Asher
- 11Neuroscience Institute, Carolina Neurosurgery and Spine Associates, Carolinas HealthCare System, Charlotte, North Carolina
| | - Michael S. Virk
- 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York
| | | | - Mohammed Ali Alvi
- 5Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jian Guan
- 15Pacific Neurosciences Center, Torrance, California
| | - Regis W. Haid
- 16Atlanta Brain and Spine Care, Atlanta, Georgia; and
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15
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Yerneni K, Nichols N, Abecassis ZA, Karras CL, Tan LA. Preoperative Opioid Use and Clinical Outcomes in Spine Surgery: A Systematic Review. Neurosurgery 2020; 86:E490-E507. [DOI: 10.1093/neuros/nyaa050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 01/11/2020] [Indexed: 01/09/2023] Open
Abstract
AbstractBACKGROUNDPrescription opioid use and opioid-related deaths have become an epidemic in the United States, leading to devastating economic and health ramifications. Opioids are the most commonly prescribed drug class to treat low back pain, despite the limited body of evidence supporting their efficacy. Furthermore, preoperative opioid use prior to spine surgery has been reported to range from 20% to over 70%, with nearly 20% of this population being opioid dependent.OBJECTIVETo review the medical literature on the effect of preoperative opioid use in outcomes in spine surgery.METHODSWe reviewed manuscripts published prior to February 1, 2019, exploring the effect of preoperative opioid use on outcomes in spine surgery. We identified 45 articles that analyzed independently the effect of preoperative opioid use on outcomes (n = 32 lumbar surgery, n = 19 cervical surgery, n = 7 spinal deformity, n = 5 “other”).RESULTSPreoperative opioid use is overwhelmingly associated with negative surgical and functional outcomes, including postoperative opioid use, hospitalization duration, healthcare costs, risk of surgical revision, and several other negative outcomes.CONCLUSIONThere is an urgent and unmet need to find and apply extensive perioperative solutions to combat opioid use, particularly in patients undergoing spine surgery. Further investigations are necessary to determine the optimal method to treat such patients and to develop opioid-combative strategies in patients undergoing spine surgery.
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Affiliation(s)
- Ketan Yerneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noah Nichols
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
| | - Zachary A Abecassis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Constantine L Karras
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, California
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16
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Bui G, Gao Y, Glass N, Cychosz C, Marsh JL, Phisitkul P. Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers' Compensation. Foot Ankle Int 2020; 41:17-24. [PMID: 31650857 DOI: 10.1177/1071100719879648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Workers' compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. METHODS With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. RESULTS The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI (P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI (P = .02). Female sex was a risk factor for SPI in the non-WC population. CONCLUSIONS WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Gabrielle Bui
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Yubo Gao
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Natalie Glass
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Durand Z, Nechuta S, Krishnaswami S, Hurwitz EL, McPheeters M. Prevalence and Risk Factors Associated With Long-term Opioid Use After Injury Among Previously Opioid-Free Workers. JAMA Netw Open 2019; 2:e197222. [PMID: 31314119 PMCID: PMC6647548 DOI: 10.1001/jamanetworkopen.2019.7222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Using opioids for acute pain can lead to long-term use and associated morbidity and mortality. Injury has been documented as a gateway to long-term opioid use in some populations, but data are limited for injured workers. OBJECTIVE To evaluate the prevalence and risk factors of long-term opioid use after injury among workers in Tennessee who were opioid free at the time of injury. DESIGN, SETTING, AND PARTICIPANTS This cohort study identified injured workers aged 15 to 99 years who reported only 1 injury to the Tennessee Bureau of Workers' Compensation from March 2013 to December 2015 and had no opioid prescription in the 60 days before injury. Participants were matched to their prescription history in Tennessee's prescription drug monitoring program. Analysis was conducted from November 2017 to March 2018. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% CIs for associations of demographic, injury, and opioid use variables with long-term use. MAIN OUTCOMES AND MEASURES The primary outcome was long-term opioid use, defined as having an opioid supplied for 45 or more days in the 90 days after injury. RESULTS Among 58 278 injured workers who received opioids after injury (18 977 [32.5%] aged 15-34 years, 27 514 [47.2%] aged 35-54 years, and 11 787 [20.2%] aged 55-99 years; 32 607 [56.0%] men), 46 399 (79.6%) were opioid free at the time of injury. Among opioid-free injured workers, 1843 (4.0%) began long-term opioid use. After controlling for covariates, long-term use was associated with receiving 20 or more days' supply in the initial opioid prescription compared with receiving less than 5 days' supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared with visiting 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29). However, even just 5 days' to 9 days' supply was associated with an increase in the odds of long-term use compared with less than 5 days' supply (OR, 1.83; 95% CI, 1.56-2.14). CONCLUSIONS AND RELEVANCE In this study of injured workers, injury was associated with long-term opioid use. The number of days' supply of the initial opioid prescription was the strongest risk factor of developing long-term use, highlighting the importance of careful prescribing for initial opioid prescriptions.
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Affiliation(s)
- Zoe Durand
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- University of Hawai‘i at Mānoa, Office of Public Health Studies, Honolulu
| | - Sarah Nechuta
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Eric L. Hurwitz
- University of Hawai‘i at Mānoa, Office of Public Health Studies, Honolulu
| | - Melissa McPheeters
- Office of Informatics and Analytics, Tennessee Department of Health, Nashville
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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Jain N, Phillips FM, Weaver T, Khan SN. Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion. Spine (Phila Pa 1976) 2018; 43:1331-1338. [PMID: 29561298 DOI: 10.1097/brs.0000000000002609] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, economic analysis. OBJECTIVE To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. SUMMARY OF BACKGROUND DATA Chronic opioid use is associated with poor outcomes and dependence after spine surgery. Risk factors, complications, readmissions, adverse events, and costs associated with COT in patients undergoing lumbar fusion are not entirely known. As providers look to reduce healthcare costs and improve outcomes, identification of modifiable risk factors is important. METHODS Commercial insurance data from 2007 to Q3-2015 was used to study preoperative opioid use in patients undergoing primary one- to two-level PLF. Ninety-day complications, ED visits, readmissions, 1-year adverse events, and associated costs have been described. Multiple-variable regression analyses were done to study preoperative COT patient profile and opioid use as a risk factor for complications and adverse events. RESULTS A total of 24,610 patients with a mean age of 65.6 ± 11.5 years were included. Five thousand five hundred (22.3%) patients had documented opioid use for more than 6 months before surgery, and 87.4% of these had continued long-term use postoperatively. On adjusted analysis, preoperative COT was found to be a risk factor for 90-day wound complications, pain diagnoses, ED visits, readmission, and continued use postoperatively. Postspinal fusion long-term opioid users had an increased utilization of epidural/facet joint injections, risk for revision fusion, and increased incidence of new onset constipation within 1 year postsurgery. The cost associated with increase resource use in these patients has been reported. CONCLUSION Preoperative COT is a modifiable risk factor for complications, readmission, adverse events, and increased costs after one- or two-level PLF. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Nikhil Jain
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Frank M Phillips
- Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, IL
| | - Tristan Weaver
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Safdar N Khan
- The Ohio State University Wexner Medical Center, Columbus, OH
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Variables Affecting Return to Work After Spinal Surgery in a Non-workers' Compensation Population: A Retrospective Cohort Study. J Am Acad Orthop Surg 2017; 25:e282-e288. [PMID: 29176507 DOI: 10.5435/jaaos-d-17-00098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Return-to-work (RTW) outcomes following spine surgery are critical information for patients aspiring to return to employment following surgical correction. Among patients receiving workers' compensation (WC), spinal surgery has been repeatedly linked to poor RTW rates. However, among patients not receiving WC, the percentage of patients who return to employment is unclear. METHODS We conducted a retrospective cohort study of 326 non-WC patients who underwent spinal surgery at two institutions. We determined RTW status and analyzed potential predictors of RTW status. RESULTS Preoperative work status was the only markedly positive predictor of RTW status; patients who were working prior to their surgery were more likely to return to work after surgery. Patients with at least one comorbidity were less likely to return to employment. All other sociodemographic, surgery-related, and complication variables did not reach statistical significance. However, smoking status, short fusion, and cervical fusion were clinically relevant predictors of a negative RTW status. DISCUSSION Among non-WC patients, employment before surgery was a positive predictor for RTW status. For patients with a positive comorbidity status, a lower likelihood of returning to employment is predicted. Randomized trials are needed to fully explore the effect of predictor variables on RTW status among non-WC patients. CONCLUSIONS Patients not receiving WC who underwent spinal surgery had a high chance of returning to employment within 1 year if they had been working at least 3 months before the date of surgery.
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Marchi L, Nogueira-Neto J, Amaral V, Amaral R, Faulhaber N, Coutinho E, Oliveira L, Jensen R, Pimenta L. WORKERS' COMPENSATION IS ASSOCIATED WITH WORST CLINICAL RESULTS AFTER LUMBAR FUSION. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604174270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: The objective of this study was to evaluate the association of clinical results with preoperative situation of worker compensation (WC) in patients submitted to spine surgery. Methods: This was a retrospective, comparative, single center study. Patients who underwent lumbar spine arthrodesis were included. The outcomes were pain scores (VAS), physical constraint (ODI) and quality of life (EQ-5D). Outcomes were analyzed before surgery and after surgery (minimum follow-up of six months and maximum of 12). Two groups were compared: individuals with or without WC at preoperative visit. Results: A total of 132 cases were analyzed (mean age 54 years and 51% female), 29 (22%) assigned to the WC group. The groups were matched for age, sex, and preoperative depression levels. In the preoperative period, the groups showed equal pain and physical constraint; however the CT group had lower quality of life (p=0.05). Although both groups showed improvement in clinical outcomes after surgery (p<0.05), worse scores were observed for the WC group compared to the non-WC group, respectively: VAS 4.9 vs. 3.2 (p=0.02), ODI 34.7 vs. 23.4 (p=0.002), and EQ-5D 0.56 vs. 0.75 (p=0.01). Conclusion: In this study it was possible to observe that WC is associated with worse clinical results following elective surgical treatment of the lumbar spine.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Luiz Pimenta
- Instituto de Patologia da Coluna, Brazil; University of California, USA
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21
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Amaral V, Marchi L, Martim H, Amaral R, Nogueira-Neto J, Pierro E, Oliveira L, Coutinho E, Marcelino F, Faulhaber N, Jensen R, Pimenta L. Influence of psychosocial distress in the results of elective lumbar spine surgery. JOURNAL OF SPINE SURGERY 2017; 3:371-378. [PMID: 29057345 DOI: 10.21037/jss.2017.08.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Low back pain can be caused by several pathological entities and its perception can be altered by external factors, for example by some psychological and social factors. The objective of this study was to compare surgical outcomes in patients with or without psychosocial issues. METHODS Single center, retrospective and comparative study. Patients with indication to elective lumbar spine surgery were screened for some psychosocial factors. As a result of the screening, patients were divided in two groups: mild psychosocial issues (green group) or moderate psychosocial issues (yellow group). The groups were compared using the following variables: demographic and clinical history, depression (HAD-D), anxiety (HAD-A), pain levels [visual analogue scale (VAS)], disability [Oswestry disability index (ODI)] and quality of life [EuroQol 5D (EQ-5D)] at preop and 6-12 months follow-up. RESULTS A total of 136 patients were included (51% female) in this study. The 62.5% were allocated at the green group, and 37.5% in the yellow group. Similar pain levels were observed at preop, but the green group evolved with superior improvement in pain levels after surgery (P=0.003). In the ODI and EQ-5D scales, the green group had already shown lower clinical disability at preop (P=0.009 and P=0.003, respectively) and evolved with better outcomes at the final evaluation (P=0.049 and P=0.017). VAS, ODI and EQ-5D scores improved from baseline similarly in both groups. CONCLUSIONS Presurgical screening identify the presence of psychological distress. Psychosocial factors are correlated with poorer clinical outcomes, both in the baseline and after the surgery. Despite the differences between found, even patients with mild psychosocial impairment can experience clinical improvement with surgery.
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Affiliation(s)
- Vivian Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | - Luis Marchi
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | - Heber Martim
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.,Hospital São Vicente de Paula, Jundiaí, SP, Brazil
| | - Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | - Ellen Pierro
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | | | | | | | | | - Rubens Jensen
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil
| | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brazil.,University of California San Diego, San Diego, CA, USA
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Affiliation(s)
- Theodore J Choma
- 1Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri 2Department of Orthopaedic Surgery, University of West Virginia, Morgantown, West Virginia
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