Surgical Outcomes in Workmanâ€™s Compensation Patients Following Minimally Invasive 1 and 2 Level Lumbar Laminectomy
Presented at SMISS Annual Forum 2014
By Kern Singh MD
With Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Islam Elboghdady , Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Anton Jorgensen MD, Andrew Park MD,
Disclosures: 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, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Andrew Park MD None,
Patients with WC claims often require lumbar decompression for work-related injuries. Despite perception biases regarding worsened outcomes in this population, the perioperative outcomes following an MIS lumbar laminectomy in WC patients have not been well characterized.
To compare the surgical outcomes associated with a 1 and 2 level minimally invasive (MIS) primary lumbar laminectomy in patients with and without Workman’s Compensation Insurance (WC).
A retrospective analysis of 85 patients who underwent a 1 and 2 level lumbar laminectomy for degenerative spinal pathology between 2005-2013 was performed. Patients were separated into two cohorts based upon the primary payor status (Workman’s Compensation (WC) vs non-WC). Patient demographics, comorbidity Index (CCI), intraoperative parameters, perioperative outcomes, and postoperative complications were assessed. Statistical analysis was performed with independent sample T tests for continuous variables and Chi-square analysis for categorical data. An alpha level of <0.05 denoted statistical significance.
85 patients underwent a primary 1 and 2 level MIS lumbar laminectomy of which 16 (19.8%) carried WC insurance. The WC cohort was younger (47.5±11.7 vs 60.6±13.4) and demonstrated a lower comorbidity burden (CCI 2.09±1.97 vs 3.83±1.86) (p<0.05). Body mass index (BMI) and pre-operative visual analogue scale (VAS) scores were comparable between the study cohorts. The WC cohort comprised a greater proportion of smokers compared to the non-WC cohort. The mean procedural time was significantly reduced in the WC cohort (44.5±17.4 vs 56.4±21.5, p<0.05). However, the mean estimated blood loss (EBL), and hospital length of stay did not significantly differ as a function of the payor status. WC patients reported higher VAS scores and demonstrated greater rates of revisions/reoperations (16.7% vs 7.5%, p=0.13), but this did not reach statistical significance. In contrast, the WC cohort was associated with significantly lower rates of perioperative complications (0.0% vs 9.0%, p<0.05).
WC patients who underwent an MIS lumbar laminectomy demonstrated lower rates of postoperative complications, but slightly worsened postoperative VAS scores, and revision/reoperations when compared with the non-WC cohort. These differences may be attributed to the greater physical demand in the WC patients. Regardless, MIS lumbar laminectomy is a safe and effective alternative to open surgery for the management of this challenging patient population.