• Erik Y Tye, Joshua T Anderson, Mhamad Faour, Arnold R Haas, Rick Percy, Stephen T Woods, Uri M Ahn, and Nicholas U Ahn.
• *Case Western Reserve University School of Medicine, Cleveland, OH †Department of Orthopedics, University Hospitals Case Medical Center, Cleveland, OH ‡Department of Orthopedics, University of Utah, Salt Lake City, UT §Ohio Bureau of Workers' Compensation, Columbus, OH ¶New Hampshire NeuroSpine Institute, Bedford, NH.
• Spine. 2017 Oct 1; 42 (19): E1140-E1146.

Study DesignRetrospective cohort study.ObjectiveTo investigate the impact of prolonged opioid use in the preoperative treatment plan of degenerative lumbar stenosis (DLS).Summary Of Background DataPatients 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.MethodsWe 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.ResultsPatients 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).ConclusionProlonged 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.Level Of Evidence3.

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