(221) Preoperative opioid use and postoperative return to work following spinal surgery in workers’ compensation settings: A systematic review and meta-analysis

Background: Opioid use before spinal surgery is common among patients with workers’ compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW).

Objectives: To assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery.

Methods:

Design: Systematic review and meta-analysis
Setting: Peer-reviewed literature that reported the relationship between preoperative opioid use and postoperative work outcomes following spinal surgery in workers’ compensation settings were searched in MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus and Web of Science from inception to January 14, 2023.
Exposures or interventions: We included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. Exposure to opioids was considered as either exposure (opioid use) versus no exposure (no opioid use) or ≥3 months use versus < 3 months use and >1-year use versus ≤ 1-year use based on how the studies defined the two groups.
Main outcome measures: The primary outcome was stable RTW after spinal surgery (returning to work within two years and maintaining work function for 3 months or longer in the following year). Secondary outcomes were RTW within 1-year after surgery.
Statistical analysis: A random effect model was assumed to pool the effect estimate. The included studies were critically appraised whether the reported relationship is adjusted for potential confounders. The GRADE approach was applied to evaluate the certainty of evidence.

Results: From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI, 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI 0.36-0.59).

Conclusions: This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.