A team from Case Western Reserve University School of Medicine recently published the results of their study about lumbar fusion and subsequent opioid use in the issue of Spine magazine. The results provide more evidence of the over-prescribing trend, a practice that can have negative results for patients.
The team sought to research opioid use after patients underwent lumbar fusion for degenerative disc injuries for an occupational injury, and how their use of opioids may or may not have affected their outcome from surgery. The researchers used CPT and ICD codes to identify and evaluate just over a thousand workers’ compensation patients who had lumbar fusion for degenerative disc disease in a 20 year period, from 1993 to 2013. They excluded patients who had already had lumbar surgery at least once, smokers, or those who had failed back syndrome so they would not skew the sample. They defined a chronic opioid therapy patient (COT) as one who was prescribed the drugs for more than one year after the initial six week recovery period, and the others they labeled temporary opioid patients.
They found that the majority of the study group turned out to be COT patients (572) rather than temporary users (427). After surgery, the COT patients took a longer time to return to work and about three-quarters of them suffered from depression and extended time away from work. Those in the COT group had medical bills almost $28,000 more expensive than those on temporary opioid therapies, and had higher rates of hiring legal representation, psychiatric disorders, and undergoing discography or additional surgeries, but lower rates of chiropractic visits.
Following up with those in the COT group three years after their surgeries, patients had had an average of 49 prescriptions and 86 percent of those were for Schedule II drugs.
Researchers think that a strong indicator of whether a patient will end up on chronic opioid therapy after surgery is whether they had already been on opioids before surgery. Those who suffered from failed back surgery were the most likely to become chronic users. Other factors that increased the likelihood of long-term use were patients who had greater instances of psychiatric issues and took more time out of work before their surgery. In general, chronic opioid use seemed to correlate with a more negative outcome overall than those who used these kinds of drugs temporarily. The researchers suggest that the fusion procedure might not be the best answer for workers’ comp patients with these kinds of injuries, given the outcomes. Lumbar fusions can have dramatically different results depending on the patient, and the use of opioids afterwards can also have dramatic effects on a patient.