This study is a retrospective review of patients' charts and data from longitudinally collected clinical outcomes and opioid use.Objective: In the current study, we aim to compare short-term outcomes data for 139 Open transforaminal interbody fusion (TLIF) patients to recently published data for tubular and endoscopic MIS-TLIF.Background Context: In response to the downsides associated with Open TLIF, such as large incision, blood loss, delayed ambulation, prolonged hospitalization, and opioid-reliance, spine surgeons developed tubular retractor based "minimallyinvasive" TLIF. However, the traditional Open TLIF retains its significance in terms of providing successful fusion and improved patient-reported outcomes (PROs).Methods: We adapted several techniques with an aim to improve short-term outcomes for our Open TLIF patients that combined extensive perioperative counselling, an emphasis on early mobilization, avoidance of overuse of opioid analgesics, early discharge with home care arrangements, use of a posthospitalization drainage tube with intraoperative surgical modifications using small incisions (4-5 cm), a narrow 20 mm retractor, minimal muscle injury, and use of a cell saver to minimize net blood loss. The demographics and perioperative results were compared with data from recent MIS-TLIF studies using Student t test for continuous and χ 2 /exact test for categorical variables.Results: Among the total 139 patients, 115 underwent a singlelevel procedure, 90% of whom were discharged on the first postoperative day (length of stay = 1.13 ± 0.47 d) with an average net estimated blood loss of 176.17 ± 87.88 mL. There were 24 two-level procedures with an average length of stay of 1.57 ± 0.84 days, average net estimated blood loss was 216.96 ± 85.70 mL. The patients had statistically significant improvements in PROs at 3 and 12 months. Conclusions:The results of this study identify that patients who underwent modified Open TLIF demonstrated favorable shortterm outcomes, as compared with the tubular MIS-TLIF, by virtue of avoidance of blood transfusions, shorter hospital stays, and significantly less opioid usage while experiencing satisfactory PROs.
The nominal species Brachidontes exustus (Linnaeus, 1758) is a cryptic complex. Long polymerase chain reactions and direct sequencing by primer walking was used to determine the complete F type mitochondrial genome of the Gulf of Mexico clade. The genome is 16,600 bp long and contains a single large unassigned presumptive control region, 13 protein-coding genes, 23 tRNA genes, and 2 rRNA genes, all coded for on the heavy chain. As in many other bivalves, there is the addition of tRNA-Met(AUA). The gene order is different from all other mitogenomes known for the family. The B. exustus mitogenome will contribute to a better understanding of the evolutionary history and phylogenetic relationships of the Mytilidae.
INTRODUCTION The opioid crisis is a national emergency. We conducted a prospective cohort study to determine whether elective spine surgery can be performed without any opioids whatsoever. METHODS Every consecutive elective spine surgery performed by author R.A.B. between January 1st and December 31st of 2018 was included. For cohort A, between January and April 15th, opioids were minimized but PRN doses were given. For cohort B, between April 15th and December, the goal was to eliminate opioids altogether. Pain scores were collected at discharge, 1 wk, and 1-mo follow-up. Patient-reported outcomes (PRO) were collected at baseline and at 3 mo for lumbar procedures. Emergency room visits and readmissions were tracked. Student's t-tests were used to compare pain scores and PROs, and multivariate regression analyses were performed to understand drivers of opioid use. RESULTS A total of 158 patients were included. In cohort A, 37.9% of patients took no opioids between PACU and 1 mo. Average pain scores were 5.2 in PACU and 2.5 at 1 mo. In cohort B, 86.7% took no opioids after PACU. Average pain scores were 4.2 in PACU and 2.5 at 1 mo. Both cohorts had equivalent improvements in PROs. Multivariate regression revealed that, adjusting for case mix differences, cohort B had lower odds of opioid use after PACU (P < .0001). Moreover, preoperative opioid use is a driver of postoperative opioid use (P = .02), whereas procedure type/invasiveness is not. CONCLUSION We have shown that opioid-free spine surgery, including lumbar fusions, is feasible and effective. In all 87% of patients in our opioid-elimination cohort took no opioids from PACU until 1 mo after surgery, and 94% were taking none at the 1-mo visit. Pain scores and PROs were favorable. We have also shown that preoperative opioids are a driver of postoperative opioid use, however procedural invasiveness is not.
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