Opioid Consumption in Workman’s Comp Patients After a Minimally Invasive Transforaminal Lumbar Interbody Fusion

Presented at SMISS Annual Forum 2014
By Abbas Naqvi BS
With Kern Singh MD, Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Islam Elboghdady , Eric Sundberg MD, Hamid Hassanzadeh MD, Anton Jorgensen MD, Khaled Aboushaala MD, Spencer Leblang ,

Disclosures: Abbas Naqvi BS None Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th, Sreeharsha Nandyala BA None, Alejandro Marquez-Lara MD None, Islam Elboghdady None, Eric Sundberg MD None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Spencer Leblang None,

There is concern regarding the potential overutilization of opioid pain medication in Workman’s compensation patients. However, the impact of WC status on peri-operative narcotic consumption after lumbar spine procedures has not been previously reported.

To assess the differences in peri-operative narcotic consumption between Workman’s compensation (WC) patients and non-Workman’s compensation (non-WC) patients following a single-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF).

A cohort of patients who underwent MIS TLIF procedures for degenerative spinal pathology between 2007-2013 were retrospectively analyzed. Patients were stratified based upon the primary payor status (WC vs. non-WC) and assessed with regards to demographics, comorbidity burden, smoking status, intraoperative parameters, rates of in-hospital complications, and length of hospitalization. Cumulative and daily (postoperative day (POD)) in-hospital narcotic requirements (expressed in oral morphine equivalent (OME) doses) were also analyzed. Statistical analysis was performed with chi-squared test for categorical variables and Student-Test for continuous variables. OME means were compared utilizing non-parametric analysis to adjust for skewedness. A p-value of <0.05 denoted statistical significance.

136 single-level primary MIS TLIF procedures were included in the analysis, of which 46 (39.1%) carried WC as the primary payor. WC patients were younger (47.8±11.2 vs. 57.5±10.1 years; p<0.05) and demonstrated a lower comorbidity burden (CCI: 1.85±1.30 vs. 3.30±2.02; p<0.05) than non-WC patients. Payor status did not significantly impact the estimated blood loss during surgery, or rates of peri-operative complications, however, WC patients incurred longer operations (135.2±52.2 vs. 119.9±34.5 min; p<0.05). Although the mean length of hospitalization was comparable between cohorts, WC patients were less likely to be discharged on POD 1 (8.3% vs. 22.0%; p<0.05). Intravenous and oral opioid administration was more common among WC patients. However, cumulative opioid requirements did not significantly differ between WC and non-WC patients regardless of the day of discharge.

Despite concerns for greater opioid abuse in the WC population, this analysis did not demonstrate significant differences in narcotic consumption between WC and non-WC patients during the immediate postoperative period. However, WC patients did demonstrate a greater proportion of intravenous and oral opioid utilization compared to non-WC patients. The narcotic consumption patterns among WC patients suggest that greater oral and intravenous opioid requirements, regardless of the OME dose, may be associated with a delay in discharge following an MIS TLIF procedure.