title: Postoperative Narcotic Consumption in Workman's Compensation Patients Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion.
abstract: METHODS
  Retrospective cohort analysis of a prospective registry.
  
  
  OBJECTIVE
  To assess the differences in perioperative narcotic consumption between Workman's compensation (WC) and non-Workman's compensation (non-WC) patients after a single-level minimally invasive transforaminal lumbar interbody fusion.
  
  
  BACKGROUND
  There is concern regarding the potential overutilization of opioid pain medication in WC patients. However, the impact of WC status on perioperative narcotic consumption after lumbar spine procedures has not been previously reported.
  
  
  METHODS
  A cohort of patients who underwent primary 1-level minimally invasive transforaminal lumbar interbody fusion procedures for degenerative spinal pathology between 2007 and 2013 was retrospectively analyzed using a prospectively collected registry. First, preoperative and perioperative characteristics were compared between WC and non-WC patients. Second, mean oral morphine equivalent was compared between WC and non-WC patients with adjustment for any preoperative or perioperative differences between cohorts.
  
  
  RESULTS
  A total of 136 single-level, primary minimally invasive-transforaminal lumbar interbody fusion procedures were included in the analysis, of which 46 (33.8%) were WC patients. WC patients were younger (47.8 ± 11.2 vs. 57.9 ± 10.4 yr; P < 0.001) and had a lower comorbidity burden (Charlson Comorbidity Index: 1.85 ± 1.30 vs. 3.42 ± 2.07; P < 0.001) than non-WC patients. The distribution of ethnicity differed between WC and non-WC patients (P = 0.002). WC patients incurred longer procedural times (135.2 ± 52.2 vs. 118.9 ± 33.7 min; P < 0.05). However, the estimated blood loss, length of hospital stay, and day of discharge were no different between WC and non-WC patients. Mean oral morphine equivalent consumption did not differ between WC and non-WC patients after adjustment for differences in age, ethnicity, Charlson Comorbidity Index, and procedural time between cohorts.
  
  
  CONCLUSIONS
  Despite concerns for greater opioid use in the WC population, this analysis demonstrated similar total narcotic consumption between WC and non-WC patients during the immediate postoperative period. Long-term studies are warranted to assess whether this similarity in regard to perioperative narcotic consumption persists beyond the immediate postoperative period.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL †Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT; and ‡Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Islam
authors.initials: I
authors.lastname: Elboghdady
authors.forename: Khaled
authors.initials: K
authors.lastname: Aboushaala
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Mayo
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011182:Postoperative Care; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D014942:Workers' Compensation / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid