在工人赔偿机构中,在手术前使用阿片类药物和在脊椎手术后在手术后恢复工作:系统审查和元分析
Yonas G Tefera1, Shannon Gray, Suzanne Nielsen2
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
International journal of surgery (London, England)
|January 5, 2024
概括
手术前使用阿片类药物显著降低了工人赔偿病人的脊椎手术后稳定恢复工作 (RTW) 的几率. 这一发现突显了阿片类药物依赖对康复和就业结果的影响.
科学领域:
- 脊柱外科手术的结果
- 疼痛管理 疼痛管理
- 职业健康 职业健康 职业健康
背景情况:
- 在接受脊柱手术的患者中,特别是那些有工人赔偿 (WC) 索赔的患者中,手术前使用阿片类药物很普遍.
- 长期使用阿片类药物与不良结果有关,包括延迟恢复工作 (RTW).
研究的目的:
- 系统地审查和元分析术前阿片类药物使用和脊柱手术后稳定的RTW之间的关联.
- 评估手术前阿片类药物使用对手术后一年内RTW的影响.
主要方法:
- 在多个数据库 (MEDLINE,Embase等) 中进行全面的文献搜索. 在2023年1月之前.
- 包括观察性研究,比较术前阿片类药物使用与不使用或不同持续时间.
- 主要结果:稳定的RTW;次要结果:一年内RTW,WC索赔费用. 使用了随机效应模型和GRADE方法.
主要成果:
- 纳入了10项研究 (9项用于定量综合),涉及5549名参与者.
- 中等确定性证据表明,手术前使用阿片类药物将术后稳定RTW的几率减半 (OR:0.51).
- 中等确定性证据表明,手术前使用阿片类药物将1年内RTW的几率降低了一半以上 (OR:0.46).
结论:
- 手术前使用阿片类药物与手术后RTW的几率降低显著相关,这些患者接受了WC资助的脊柱手术.
- 这些发现强调了手术前阿片类药物使用对该患者群体恢复工作的负面影响.
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