Chronic Opioid Therapy After Lumbar Fusion Surgery for XXXX in a Workers' Compensation Setting.

@entity1 @entity1643 @entity308 @entity1538 @entity146 @entity4784 @entity179 @entity393 @entity11252
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate prescription opioid use after lumbar fusion for @entity179 in a @entity1538 ( @entity1538 ) setting. SUMMARY OF BACKGROUND DATA: Use of opioids for treating @entity1643 has increased greatly. Few studies have evaluated risk factors for @entity4784 ( @entity4784 ) among the clinically-distinct @entity1538 population. METHODS: We used "Current Procedural Terminology" and "International Classification of Diseases, Ninth Revision" codes to identify 1002 Ohio @entity1538 subjects who underwent lumbar fusion for @entity179 from 1993 to 2013. Postoperative @entity4784 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 @entity4784 group. The remaining 427 subjects formed a temporary opioid group. To identify prognostic factors associated with @entity4784 after fusion, we used a multivariate logistic regression analysis. RESULTS: Returning to work was negatively associated with @entity4784 (P<0.001; odds ratio [OR] 0.38). @entity4784 before fusion (P<0.001; OR 6.15), @entity11252 (P<0.001; OR 3.40), additional surgery (P<0.001; OR 2.84), clinically diagnosed @entity308 (P<0.001; OR 2.34), and extended @entity393 before fusion (P=0.038; OR 1.61) were positively associated with @entity4784 . The rates of postoperative @entity4784 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 @entity4784 . Within 3 years after fusion, the @entity4784 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 @entity4784 group had an 11.0% return to work rate,  27,952 higher medical costs per subject, 43.5% rate of @entity146 comorbidity, 16.7% rate of @entity11252 , and 27.7% rate of additional lumbar surgery. CONCLUSION: The majority of the study population was on @entity4784 after fusion. @entity4784 was associated with considerably worse outcomes. The poor outcomes of this study could suggest a more limited role for discogenic fusion among @entity1538 @entity1 . LEVEL OF EVIDENCE: 3.
