Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Setting with an Enhanced Recovery After Surgery Protocol

Monk, Steve; Rossi, Vincent J.; Atkins, Tyler; Karimian, Brandon; Pfortmiller, Deborah; Kim, Paul K.; Adamson, Tim E.; McGirt, Matthew J.; Holland, Christopher M.; Deshmukh, Vinay R.; Branch, Byron C.

doi:10.1016/j.wneu.2022.12.047

Cited by 4 publications

(9 citation statements)

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“…In our cohort, only 1 patient (1%) required inpatient transfer when using a carefully constructed multimodal analgesia regimen described previously. 7 Moreover, patient satisfaction was similar between groups, suggesting that patients were not prematurely discharged and forced to suffer in pain at home, as anecdotally suggested by critics of ambulatory lumbar fusion. Together, these findings imply that MIS TLIF may be performed safely and effectively in an ASC with careful patient selection, preoperative counseling, and comprehensive care pathways.…”

Section: Discussionmentioning

confidence: 71%

“…A muscle-splitting, tubular retractor technique was used to perform MIS TLIFs in the ASC, as previously described. 7…”

Section: Surgical Techniquementioning

confidence: 99%

“…[14][15][16] These concerns have largely been refuted by studies demonstrating the safety of hospital-based outpatient MIS TLIF and the benefit of early recovery after surgery (ERAS) protocols in the ASC environment. 7,14,15 However, high-quality studies of MIS TLIF performed in a freestanding ASC are lacking. The goal of this study was to perform the first propensity-matched comparison of patients undergoing 1-level MIS TLIF in the ASC vs inpatient hospital setting.…”

mentioning

confidence: 99%

“…Numerous spine surgeries including cervical foraminotomy, lumbar decompression, and more recently anterior cervical discectomy and fusion (ACDF) have migrated to this lower cost environment as high-quality studies have demonstrated their safety and efficacy. [1][2][3][4][5][6][7][8][9][10][11][12][13] Conversely, studies regarding ambulatory minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) are limited to small case series. 3,4,8,10 The transition of MIS TLIF to the ambulatory setting has been hampered by concerns regarding inadequate pain control and catastrophic complications.…”

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confidence: 99%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: A 1-Year Comparative Effectiveness Analysis

et al. 2023

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BACKGROUND: Ambulatory surgery centers (ASCs) have emerged as an alternative setting for surgical care as part of the national effort to lower health care costs. The literature regarding the safety of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the ASC setting is limited to few small case series. OBJECTIVE: To assess the safety and efficacy of MIS TLIF performed in the ASC vs inpatient hospital setting. METHODS: A total of 775 patients prospectively enrolled in the Quality Outcomes Database undergoing single-level MIS TLIF at a single ASC (100) or the inpatient hospital setting (675) were compared. Propensity matching generated 200 patients for analysis (100 per cohort). Demographic data, resource utilization, patient-reported outcome measures (PROMs), and patient satisfaction were assessed. RESULTS: There were no significant differences regarding baseline demographic data, clinical history, or comorbidities after propensity matching. Only 1 patient required inpatient transfer from the ASC because of intractable pain. All other patients were discharged home within 23 hours of surgery. The rates of 90-day readmission (2.0%) and reoperation (0%) were equivalent between groups. Both groups experienced significant improvements in all PROMs (Oswestry Disability Index, EuroQol-5D, back pain, and leg pain) at 3 months that were maintained at 1 year. PROMs did not differ between groups at any time point. Patient satisfaction was similar between groups at 3 and 12 months after surgery. CONCLUSION: In carefully selected patients, MIS TLIF may be performed safely in the ASC setting with no statistically significant difference in safety or efficacy in comparison with the inpatient setting.

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Section: Discussionmentioning

confidence: 71%

“…A muscle-splitting, tubular retractor technique was used to perform MIS TLIFs in the ASC, as previously described. 7…”

Section: Surgical Techniquementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: A 1-Year Comparative Effectiveness Analysis

et al. 2023

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“…2). Nine studies with a total of 70,000 IPS patients and 5043 OPS patients were included for revision surgery 18,20–22,24,25,27,29,30 . The Pooled revision surgery rate was 1.9% (0%–30%) in the OPS cohorts and 3% (0%–24%) in the IPS cohorts.…”

Section: Resultsmentioning

confidence: 99%

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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Feasibility and Safety of Microendoscopic Posterior Cervical Foraminotomy in an Ambulatory Surgery Center: A Longitudinal Experience with 1000 Cases

et al. 2023

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Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Setting with an Enhanced Recovery After Surgery Protocol

Cited by 4 publications

References 30 publications

Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: A 1-Year Comparative Effectiveness Analysis

Minimally Invasive Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center Versus Inpatient Setting: A 1-Year Comparative Effectiveness Analysis

Comparison of the Safety of Inpatient Versus Outpatient Lumbar Fusion

Feasibility and Safety of Microendoscopic Posterior Cervical Foraminotomy in an Ambulatory Surgery Center: A Longitudinal Experience with 1000 Cases

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