Ninety Percent of Patients are Satisfied with their Decision to Undergo Spine Surgery for Degenerative Conditions

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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.

Section: Literature Reviewsupporting

confidence: 54%

Comparison of the Safety of Inpatient versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

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“…PROMs were collected at two weeks, six weeks, 12 weeks, six months, one year, and two years postoperatively. Two postoperative timepoints were defined—early (≤3 mo) and late (>6 mo), as previously described in the literature 31–33 …”

Section: Methodsmentioning

confidence: 99%

“…In addition, no prior Two postoperative timepoints were defined-early ( ≤ 3 mo) and late ( > 6 mo), as previously described in the literature. [31][32][33] Statistical Analysis…”

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confidence: 99%

Surgeon Experience Influences Robotics Learning Curve for Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Maayan

et al. 2023

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Study Design. Retrospective review of prospectively collected data. Objective. To analyze the learning curves of three spine surgeons for robotic minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although the learning curve for robotic MI-TLIF has been described, the current evidence is of low quality with most studies being single-surgeon series. Materials and Methods. Patients who underwent single-level MI-TLIF with three spine surgeons (years in practice: surgeon 1: 4, surgeon 2: 16, and surgeon 3: two) using a floor-mounted robot were included. Outcome measures were operative time, fluoroscopy time, intraoperative complications, screw revision, and patient-reported outcome measures. Each surgeon’s cases were divided into successive groups of 10 patients and compared for differences. Linear regression and cumulative sum (CuSum) analyses were performed to analyze the trend and learning curve, respectively. Results. A total of 187 patients were included (surgeon 1: 45, surgeon 2: 122, and surgeon 3: 20). For surgeon 1, CuSum analysis showed a learning curve of 21 cases with the attainment of mastery at case 31. Linear regression plots showed negative slopes for operative and fluoroscopy time. Both learning phase and postlearning phase groups showed significant improvement in patient-reported outcome measures. For surgeon 2, CuSum analysis demonstrated no discernible learning curve. There was no significant difference between successive patient groups in either operative time or fluoroscopy time. For surgeon 3, CuSum analysis demonstrated no discernible learning curve. Even though the difference between successive patient groups was not significant, cases 11 to 20 had an average operative time of 26 minutes less than cases 1–10), suggesting an ongoing learning curve. Conclusions. Surgeons who are well-experienced can be expected to have no or minimal learning curve for robotic MI-TLIF. Early attendings are likely to have a learning curve of around 21 cases with the attainment of mastery at case 31. Learning curve does not seem to impact clinical outcomes after surgery. Level of Evidence. Level 3.

“…As this population continues to grow, procedures to alleviate pain are becoming increasingly common. Both anterior cervical discectomy and fusion (ACDF) and cervical disk replacement (CDR) procedures have been extensively studied for efficacy and safety, and in the appropriate patient population, the two surgeries are effective in improving disability 3–7 …”

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confidence: 99%

“…Both anterior cervical discectomy and fusion (ACDF) and cervical disk replacement (CDR) procedures have been extensively studied for efficacy and safety, and in the appropriate patient population, the two surgeries are effective in improving disability. [3][4][5][6][7] Although safety and efficacy have been established, little research has described the recovery kinetics following these surgeries. This is an especially significant gap in the literature as preoperative counseling is important for patients to understand the postoperative recovery after their procedure.…”

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confidence: 99%

Recovery Kinetics Following Cervical Spine Surgery

Subramanian,

Shinn,

Korsun

et al. 2023

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Study Design. Retrospective review of a prospectively maintained multi-surgeon registry. Objective. To study recovery kinetics and associated factors following cervical spine surgery. Summary of Background Data. Few studies have described return to activities cervical spine surgery. This is a big gap in the literature as preoperative counseling and expectations before surgery are important. Materials and Methods. Patients that underwent either anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) were included. Data collected included preoperative patient-reported outcome measures, return to driving, return to working, and discontinuation of opioids data. A multivariable regression was conducted to identify the factors associated with return to driving by 15 days, return to working by 15 days, and for discontinuing opioids by 30 days. Results. 70 ACDF patients and 70 CDR patients were included. Overall, 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively; 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of 7 and 6 days. Though not significant, minimal (odds ratio (OR)=1.65) and moderate (OR=1.79) disability was associated with greater odds of returning to driving by 15 days. Sedentary work (OR=0.8) and preoperative narcotics (OR=0.86) were associated with decreased odds of returning to driving by 15 days. Medium (OR=0.81) and heavy (OR=0.78) intensity occupations were associated with decreased odds of returning to work by 15 days. High school education (OR=0.75), sedentary work (OR=0.79), retired/not working (OR=0.69) were all associated with decreased odds of discontinuing opioids by 30 days. Conclusion. Recovery kinetics for ACDF and CDR as comparable. Most patients return to all activities following ACDF and CDR, within 16 days. These findings serve as an important compass for preoperative counseling.