6 key notes on chronic opioid therapy for workers compensation spinal fusions


A new study published in Spine examines prescription opioid use after lumbar fusion for workers compensation patients.

The study examined the CPT and ICD-9 codes for the Ohio WC patients who underwent lumbar fusion for degenerative disc disease from 1993 to 2013. There were 1,002 patients who received surgery during that time and 575 patients were in the chronic opioid therapy group, who received opioid analgesics for more than one year after the six-week acute period after fusion; there were 427 patients in the temporary opioid group.


The researchers found:


1. Chronic opioid therapy was negatively associated with returning to work.


2. These factors were positively associated with chronic opioid therapy:


• Chronic opioid therapy before the spinal fusion: 27.8 percent
• Failed back syndrome: 79.6 percent
• Additional surgery: 85 percent
• Clinical depression: 76.4 percent
• Extended work loss: 77.1 percent


3. A higher opioid use preoperatively and the length of time it was used were positively associated with higher postoperative chronic opioid therapy rates.


4. Three years after fusion, the patients in the chronic opioid therapy group had an average of 1,083 days of opioids and 49 opioid prescriptions; 86.2 percent of the prescriptions were Schedule II.


5. The patients in the chronic opioid therapy group reported an 11 percent return to work rate and $27,952 higher medical costs.


6. The chronic opioid therapy patients had a 43.5 percent rate of psychiatric comorbidity, 16.7 percent rate of failed back syndrome and 27.7 percent additional lumbar surgery rate.


"The poor outcomes of this study could suggest a more limited role for discogenic fusion among WC patients," concluded the study authors.


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