A comparison of narcotic usage and length of post-operative hospital stay in open versus minimally invasive lumbar interbody fusion with percutaneous pedicle screws

Vora, Darshan; Kinnard, Matthew; Falk, David; Hoy, Michael; Gupta, Sachin; Piper, Christine C.; Yu, Warren; Siddiqui, Faisal; O’Brien, Joseph R.

doi:10.21037/jss.2018.08.04

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…This would be relevant in that there is a trend in the literature for shorter postoperative recovery time, shorter time to mobilization, and decreased postoperative pain with MIS techniques for spine surgery. [23][24][25] Despite these differences in recovery, there was no difference in complication rates based on surgical technique, and thus it is unlikely to impact the findings of this study. In addition, differences in postoperative pain management between inpatient and outpatient cohorts could have impacted the observed results in that opioid use is associated with adverse effects including gastrointestinal dysfunction, respiratory depression, and urinary retention.…”

Section: Discussionmentioning

confidence: 72%

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Karukonda

Mancini

Katz

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To compare the incidence of complications in patients undergoing single-level and 2-level lumbar laminectomy in either the inpatient or outpatient settings. Methods: Patients who underwent single-level and 2-level lumbar laminectomy were identified in the ACS NSQIP database from the years 2006 to 2015. Independent patient variables were recorded, including demographics and preoperative health characteristics. Logistic regression was used to determine the risk of postoperative complications for both a 1- and 2-level lumbar laminectomy as well as to identify independent risk factors for a complication. Comparisons were made between 2 groups: (1) inpatient and (2) outpatient as determined by billing data. Results: A total of 18 076 single- and 2-level lumbar laminectomy cases were identified with 10 743 (59.4%) inpatient procedures and 7333 (40.6%) outpatient procedures. The incidence of any postoperative complication was significantly lower in the outpatient group than in the inpatient group among all cohorts including 1-level lumbar laminectomy (1.9% vs 6.7%), 2-level lumbar laminectomy (3.17% vs 7.38%), as well as in the combined cohort of 1- and 2-level laminectomies (2.47% vs 7.01%). Significant independent risk factors for complications after lumbar laminectomy were identified, including body mass index (BMI) >30 kg/m2, age ≥55 years, a functional status of partially dependent, chronic obstructive pulmonary disease (COPD), chronic steroid use, American Society of Anesthesiologists (ASA) class 3 or 4, and operative time >90 minutes. Conclusions: This study reports a lower overall complication rate in the 30-day postoperative period following 1- and 2-level lumbar laminectomy performed in an outpatient versus inpatient setting. Significant risk factors for complications included BMI >30 kg/m2, age ≥55 years, a functional status of partially dependent, COPD, chronic steroid use, ASA class 3 or 4, and operative time >90 minutes.

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Section: Discussionmentioning

confidence: 72%

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Karukonda

Mancini

Katz

et al. 2019

Global Spine Journal

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“…In recent years, the literature has highlighted reductions in postoperative opioid use as further evidence of the superiority of the tubular MIS approach. Vora et al 13 are frequently cited for their 2018 comparison study reporting significantly more total inpatient opioid usage for Open TLIF versus MIS-TLIF (442.06 MME vs. 278.48 MME; P = 0.03). However, there are several limitations to this study: (1) the study was not controlled for preoperative opioid usage; (2) they performed lateral lumbar interbody fusions, not the Wiltse tubular TLIF; (3) they reported total inpatient opioid usage rather than daily usage, which when corrected for the difference in LOS for the 2 cohorts (6.19 for Open vs. 4.10 for MIS-LLIF; P = 0.02), gives a nearly equivalent average daily opioid usage (71.4 mg/d for Open and 67.9 mg/d for MIS).…”

Section: Discussionmentioning

confidence: 99%

Perioperative Modifications to the Open TLIF Provide Comparable Short-term Outcomes to the MIS-TLIF

Berkman¹,

Wright²,

Khan³

et al. 2021

Clinical Spine Surgery: A Spine Publication

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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.

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“…Representative techniques include the extrapleural approach that reaches the thoracic vertebrae without thoracotomy [4] , the retroperitoneal approach that reaches the lumbar vertebrae without laparotomy [5] , etc. of percutaneous pedicle screws (PPS) from the posterior approach minimized the surgical trauma of the combined anterior-posterior surgery as much as possible [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

“…The development of the lateral lumbar interbody fusion (LLIF) [6] , [7] , [8] , [9] facilitated decreased surgical insult, enabling minimally invasive spinal reconstruction from the anterior approach. Furthermore, the use of percutaneous pedicle screws (PPS) from the posterior approach minimized the surgical trauma of the combined anterior-posterior surgery as much as possible [10] , [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

The usefulness and safety of the simultaneous parallel anterior and posterior combined lumbar spine surgery using intraoperative 3D fluoroscopy-based navigation (SPAPS)

Ikuma

Hirose

Takao

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: The combined anterior-posterior surgery in the lateral decubitus position generally needs the intraoperative repositioning. However, prolonged surgical time and increased medical costs due to intraoperative repositioning have been problematic. In recent years, there have been reports of combined anterior-posterior procedure with a single position performing anterior and posterior fixation consecutively where the patient remains in the lateral decubitus position (single surgeon method-SS method). We had further advanced this method, and have adopted the S imultaneous P arallel A nterior and P osterior combined lumbar spine S urgery using intraoperative 3D fluoroscopy-based navigation (SPAPS method), where anterior and posterior procedure are performed independently by two spine surgeons.Methods: 66 cases that underwent SPAPS method (n = 37) and SS method (n = 29) from 2015 to 2019 at single institution were concluded in this study. The pre-and post-operative changes in the following were compared retrospectively between the two groups: surgical factors and clinical evaluations including JOA back pain evaluation questionnaire (JOABPEQ), visual analogue scale (VAS) on lower back pain, buttock/lower limb pain, and buttock/lower limb numbness, and Roland-Morris disability questionnaire (RDQ). Results:The SPAPS method was able to significantly reduce the surgical time (p = 0.0025) compared to the SS method, and allowed a reduction of approximately 24.4 minutes per segment. The estimated blood loss were similar in both groups, and with regards to post-operative outcomes, both groups improved equally well. The rates of screw deviation and fusion were also similar. Conclusions:In the case of performing the combined anterior-posterior surgery under a single position, the anterior and posterior procedure can be performed independently and simultaneously by two spine surgeons by utilizing the 3D fluoroscopy-based navigation. The surgical time can be significantly reduced by approximately 24.4 minutes per segment comparing to the SS method.

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A comparison of narcotic usage and length of post-operative hospital stay in open versus minimally invasive lumbar interbody fusion with percutaneous pedicle screws

Cited by 12 publications

References 24 publications

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Lumbar Laminectomy in the Outpatient Setting Is Associated With Lower 30-Day Complication Rates

Perioperative Modifications to the Open TLIF Provide Comparable Short-term Outcomes to the MIS-TLIF

The usefulness and safety of the simultaneous parallel anterior and posterior combined lumbar spine surgery using intraoperative 3D fluoroscopy-based navigation (SPAPS)

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