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 V. 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,

Introduction:
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.

Aims/Objectives:
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).

Methods:
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.

Results:
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.

Conclusions:
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.