• Mhamad Faour, Joshua T Anderson, Arnold R Haas, Rick Percy, Stephen T Woods, Uri M Ahn, and Nicholas U Ahn.
• *University Hospitals Case Medical Center Department of Orthopaedics, Case Western Reserve University School of Medicine 11100 Euclid Avenue, Cleveland, OH 44106 †Ohio Bureau of Workers' Compensation, BWC 30 W. Spring St. Columbus, OH 43215 ‡New Hampshire NeuroSpine Institute, 4 Hawthorne Drive Bedford, NH 03110.
• Spine. 2016 May 24.

Study DesignRetrospective comparative cohort study.ObjectiveExamine the impact of prolonged preoperative opioid use on return to work status after single-level cervical fusion for radiculopathy.Summary Of Background DataThe use of opioids has a dramatic impact 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.MethodsData of patients who underwent single-level cervical fusion for radiculopathy and had received opioid prescriptions prior to surgery was retrospectively collected from Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011 after work-related injury. Then, based on opioid use duration, Short-term use (STO) group (<3months), Intermediate-term use (ITO) group (3-6months), and Long-term use (LTO) group (>6months) were constructed. A multivariate logistic regression analysis was used to determine whether successful return to work (RTW) status was achieved. Chi-square and ANOVA tests were used to compare other secondary outcomes after surgery.ResultsProlonged preoperative opioid use was a negative predictor of successful RTW status (OR = 0.73; 95% CI: 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) as well as RTW within one 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 to STO group. The odds of RTW < 1year after surgery were 0.43 (0.21-0.88) for ITO, and 0.36 (0.21-0.62) for LTO compared to 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).ConclusionProlonged preoperative opioid use was associated with poor functional outcomes after cervical fusion. Short-term opioid use and earlier inclusion of the surgical approach in the management plan may offer better surgical and functional outcomes after cervical fusion.Level Of Evidence3.

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