Preoperative opioid use is a predictor of poor return to work in Workersʼ Compensation patients after lumbar diskectomy

STUDY DESIGN:Retrospective cohort OBJECTIVE:Determine the impact of preoperative opioid use in workersʼ compensation (WC) patients undergoing lumbar diskectomy (LD). SUMMARY OF BACKGROUND DATA:The prevalence of back pain among opioid users approached 60%. Long term opioid dependence in spine surgery patients is roughly 20%. Despite pervasive use, there is no evidence to support long-term opioid analgesic use for back pain. METHODS:10,592 patients received compensation from the Ohio Bureau of Workersʼ Compensation for a lumbar disc herniation between 2005-2012. Patients with spine comorbidities, smoking history, or multilevel surgery were excluded. Preoperatively, 566 patients had no opioid use, 126 had short term opioid use (STO), 315 had moderate opioid use (MTO), and 279 had long term opioid use (LTO). The primary outcome was whether subjects returned to work (RTW). RESULTS:712 (55.4%) of patients met our RTW criteria. There was a significant difference in RTW rates among the no opioid (64.1%), MTO (52.7%), and LTO (36.9%) populations. Multivariate logistic regression analysis found several covariates to be independent negative predictors of RTW statuspreoperative opioid use (P