Impact of Ambulatory Setting for Workers’ Compensation Patients Undergoing One-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion and Review of the Literature

Nie, James W.; Hartman, Timothy J.; Pawlowski, Hanna; Prabhu, Michael C.; Vanjani, Nisheka N.; Oyetayo, Omolabake O; Singh, Kern

doi:10.1016/j.wneu.2022.07.136

Cited by 5 publications

(7 citation statements)

References 55 publications

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“…Qualitatively, all six studies reported no difference between IPS and OPS cohorts for VAS Back, five of which similarly reported no difference for VAS Leg 23,26,27,30,31 . Only Nie et al reported a significant difference between groups for VAS Leg at one year , with the OPS cohort having a lower VAS Leg at this time point 19 . Two 26,31 of the four 19,26,27,31 studies that reported ODI found a significant improvement for OPS compared with IPS.…”

Section: Resultsmentioning

confidence: 92%

“…Only Nie et al reported a significant difference between groups for VAS Leg at one year , with the OPS cohort having a lower VAS Leg at this time point 19 . Two 26,31 of the four 19,26,27,31 studies that reported ODI found a significant improvement for OPS compared with IPS. The one study that reported the EuroQol-5D found no difference between the groups 21 (Table 2).…”

Section: Resultsmentioning

confidence: 93%

“…In our review, only six studies compared PROMs between inpatient and outpatient fusion groups, most often reporting VAS Back, VAS Leg, and ODI. 19,23,26,27,30,31 Qualitatively, all six studies reported no difference between IPS and OPS cohorts for VAS Back, five of which similarly reported no difference for VAS Leg. 23,26,27,30,31 Only Nie et al reported a significant difference between groups for VAS Leg at one year , with the OPS cohort having a lower VAS Leg at this time point.…”

Section: Patient-reported Outcomesmentioning

confidence: 89%

“…23,24,31 Of the 14 papers included, only four generated matched cohorts of similar patients. 19,20,25,27 These papers frequently matched patients on age, BMI, sex, race, diabetic status, smoking status, hypertension status, ASA class, and CCI, largely accounting for differences that may exist in baseline demographics. All four of these matched cohorts demonstrated no significant differences in safety between OPS and IPS cohorts, concluding that in appropriately selected patients, outpatient surgery is a safe option.…”

Section: Discussionmentioning

confidence: 99%

“…Seven studies with a total of 69,807 IPS patients and 4197 OPS patients were included for medical complications. [18][19][20][21][22]24,25 The meta-analysis of 7 studies showed a significantly decreased odds of medical complication rates among OPS compared with IPS [OR = 0.58 (0.34-0.50), P < 0.001, I2 = 28.5%] (Fig. 4).…”

Section: Medical and Surgical Complicationsmentioning

confidence: 99%

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Comparison of the Safety of Inpatient Versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

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Study Design. Systematic Review and Meta-Analysis Objective. The objective of this study is to synthesize the early data regarding and analyze the safety profile of outpatient lumbar fusion. Summary of Background Data. Preforming lumbar fusion in an outpatient or ambulatory setting is becoming an increasingly employed strategy to provide effective value-based care. As this is an emerging option for surgeons to employ in their practices, the data is still in its infancy. Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that described outcomes of inpatient and outpatient lumbar fusion cohorts were searched from PubMed, Medline, The Cochrane Library, and Embase. Rates of individual medical and surgical complications, readmission, and reoperation were collected when applicable. Patient reported outcomes were additionally collected if reported. Individual pooled comparative meta-analysis was performed for outcomes of medical complications, surgical complications, readmission, and reoperation. Patient reported outcomes were reviewed and qualitatively reported. Results. The search yielded 14 publications that compared outpatient and inpatient cohorts with a total of 75,627 patients. Odds of readmission demonstrated no significant difference between outpatient and inpatient cohorts (OR=0.94 [0.81 - 1.11]). Revision surgery similarly was no different between the cohorts (OR=0.81 [0.57 - 1.15]). Pooled medical and surgical complications demonstrated significantly decreased odds for outpatient cohorts compared to inpatient cohorts (OR=0.58 [0.34 - 0.50], OR=0.41 [0.50 - 0.68] respectively). Patient reported outcome measures were largely the same between the cohorts when reported, with few studies showing better ODI and VAS-Leg outcomes among outpatient cohorts compared to inpatient cohorts. Conclusion. Preliminary data regarding the safety of outpatient lumbar fusion demonstrates a favorable safety profile in appropriately selected patients, with patient reported outcomes remaining comparable in this setting. There is no data in the form of prospective and randomized trials which is necessary to definitively change practice.

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