1560. Effect of Pre-surgical Employment and Post-operative Opiate Use on 3-Month Return-to-Work Following Lumbar Spinal Fusion

Authors: Robert Heller, MD; Melissa Dunbar, MPH; Nasya Mendoza-Elias, MD; Robert Whitmore, MD; Zoher Ghogawala, MD (Boston, MA)

Introduction: Return to work is an important economic and quality of life goal after lumbar spinal fusion surgery. Reduction of overall opioid utilization has become a national priority. The role of pre-surgical employment and post-operative opiate pain medication use and their effects on rates of return to work remains incompletely understood. Methods: Patients from the prospective Lahey Lumbar Spine Registry undergoing 1-2 level spinal fusions from 2015-2018 with 3 month follow-up were included in the analysis. Patients with pre-operative opiate use and those self-identifying as retired before surgery were excluded. Using a novel algorithm to extract opiate use from the electronic health record, all patients receiving an opiate prescription within 90 days after surgery were identified. Results: The population consisted of 98 patients (49% male) with a median age of 58.5 years. Pre-operatively, 75 patients (77%) worked before surgery. Thirty-seven of 98 patients (38%) returned to work at 3 months. Of the 75 patients working before surgery, 36 (48%) returned to work while 1/23 patients (4%) not working before surgery returned to work. Additional opiate prescriptions were provided for 46 patients (47%) within 90 days of surgery. Patients employed before surgery were less likely to receive additional narcotics prescriptions than unemployed patients (39% vs. 74%, P <0.01). Pre-operative employment was highly associated with return to work at 3 months (P<0.01). There was no association between additional opiate prescriptions within 90 days after surgery and return to work at 3 months ( P =0.79). Conclusion: Opiate use in the immediate post-operative period does not adversely affect return to work within 3 months in opiate naïve patients. Pre-operative employment is highly associated with early return to work following 1-2 level lumbar spine fusion surgery.