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)
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.
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.
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).
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.