Peri-Operative Opioid Requirements Associated with Workman’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,

Introduction:
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.

Aims/Objectives:
To assess the impact of Workman’s compensation (WC) insurance on the postoperative narcotic consumption following a minimally invasive (MIS) lumbar decompression (LD)

Methods:
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.

Results:
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.

Conclusions:
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.