Postoperative Narcotic Consumption Following Anterior Lumbar Interbody Fusion: A Workman’s Compensation Patient Analysis

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, Aamir Iqbal BS, Sriram Sankaranarayanan 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, Aamir Iqbal BS None, Sriram Sankaranarayanan 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 postoperative narcotic consumption after lumbar spine procedures has not been previously reported.

Aims/Objectives:
To assess the differences in postoperative narcotic consumption between Workman’s compensation (WC) patients and non-Workman’s compensation (non-WC) patients following a one- and two-level anterior lumbar interbody fusion (ALIF).

Methods:
A cohort of patients who underwent a primary ALIF procedure 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 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 87 one- and two-level ALIF procedures were identified, of which 24 (27.6%) carried WC as the primary payor. WC patients demonstrated a lower comorbidity burden (CCI: 1.17±1.04 vs 2.21±2.17; p<0.05) than non-WC patients. They type of payor did not significantly impact the length of surgery, blood loss, peri-operative complications, or length of hospitalization. In the WC cohort, the mean POD 2 OME dose was significantly greater in patients discharged on POD 3 or later compared to patients discharged on POD 2 (38.6±13.2 vs 24.6±16.6, p<0.05). However, cumulative opioid requirements were comparable between WC and non-WC patients for each discharge day.

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, greater POD 2 OME dose was associated with a delay of discharge in WC patients. Further studies are warranted to help characterize the narcotic consumption patterns of WC patients undergoing spinal surgery.