Peri-Operative Opioid Requirements Associated with Workmanâ€™s Compensation Claims Following a Minimally Invasive Lumbar Decompression
Presented at SMISS Annual Forum 2014
By Islam Elboghdady
With Kern Singh MD, Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Anton Jorgensen MD, Khaled Aboushaala MD, Aamir Iqbal BS,
Disclosures: Islam Elboghdady 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, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Aamir Iqbal BS None,
Narcotic drug overuse is a potential concern among the WC population. As such, WC patients represent a challenge for surgeons and ancillary staff to appropriately manage pain in the immediate postoperative period.
To assess the impact of Workman’s compensation (WC) insurance on the postoperative narcotic consumption following a minimally invasive (MIS) lumbar decompression (LD)
A retrospective review of patients who underwent a primary one- or two-level MIS LD procedure (laminectomy or diskectomy) for degenerative spinal pathology by a single surgeon between 2006-2013 was perfomed. 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 a 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.
A total of 335 MIS LD procedures were identified, of which 115 (34.3%) carried WC as the primary payor. WC patients were younger (42.1±10.8 vs 48.1±15.9, p<0.05) and demonstrated a lower comorbidity burden (CCI: 1.32±1.54 vs 2.26±2.11, p<0.05) than non-WC patients. They type of insurance did not significantly impact the surgical times, and length of hospitalization. The majority of patients in both cohorts were discharged on POD 0 (83.3% vs 75.0%, p=0.09). Although not statistically significant, non-WC patients demonstrated a higher rate of urinary retention (1.9% vs 0%, p=0.19). Cumulative narcotic consumption was greater in WC patients discharged on POD 0 (20.6±11.9 vs 16.9±11.4, p<0.05) and POD 2 (145.7±116.4 vs 36.7±23.3, p<0.05) compared to non-WC patients discharged on the same days. Both cohorts demonstrated a delay in discharge with increasing daily OME dose.
WC patients were associated with greater narcotic consumption compared to non-WC patients in the early postoperative period. This analysis demonstrated that although the majority of patients (WC: 83.3% and non-WC 75.0%) were discharged on the same day of surgery following a MIS LD, greater daily OME dosing was associated with a delay in discharge regardless of the type of insurance. The higher narcotic requirement in WC patients did not result in a greater risk of opioid-related side effects or delay in discharge compared to non-WC patients.