Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

Abstract

We sought to evaluate differences in perioperative baseline characteristics, operative efficiency, and 30-day safety events for patients undergoing standalone minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) in a hospital versus an ambulatory surgery center (ASC). Methods Patients were retrospectively identified and sequentially enrolled from the office records of a single, community neurosurgeon. Records for the first 50 qualifying patients in the hospital and ASC cohorts were retrieved. Variables collected included: baseline demographic and health status, operative safety (intra-op complications) and efficiency (operative time, fluoroscopy time, etc.), and 30-day post-operative safety (emergency room visits, re-admission, and re-operation). Results At baseline, hospital and ASC patients were equivalent in gender distribution, BMI, and pre-operative narcotic use. Statistically significant differences were found in age and comorbidity burden (ASA status and Charleson Comorbidity Index); p < 0.0001, p = 0.0039, and p < 0.001 respectively. The only significant difference in construct type between hospital and ASC patients was the proportion of one-versus two-level fusions; all two-level fusions were performed in the hospital group. There were no differences in operative time, need for transfusions, or iatrogenic complications. There were also no differences between the groups in 30-day events of ER visits, re-admission, re-operation, or post-operative narcotic refill use. The length of stay was significantly different between the ASC and hospital settings (p < 0.0001). Conclusions As expected, ASC patients were younger and relatively healthier compared to their hospital counterparts. Thirty-day safety events of ER visits, re-admission, re-operation, and narcotic refill utilization were representative of population norms. Patients with standalone, expandable MIS-TLIF underwent efficient operative procedures and experienced minimal 30-day complications independent of their operative status. ASC patients had the added benefit of significantly reduced length of stay over their hospital counterparts. Given the equivalency of the 30-day post-operative course for both patient cohorts, a substantial reduction in economic burden is likely for the ASC patients.

Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 1: Multi-Center Assessment of Surgical Safety

“…This multi-center study extends previously reported single-center findings [ 9 ], and provides procedural and 30 day safety outcomes for patients having a minimally-invasive TLIF procedure with the stand-alone VariLift ® -LX expandable interbody fusion device in the ASC compared to the traditional hospital setting.…”

“…Indeed, Heemskerk et al [ 8 ] recently reported that patients treated with minimally-invasive TLIF have similar two-year clinical outcomes as patient having open TLIF. Correspondingly, findings have been reported demonstrating the feasibility, safety and clinical utility of performing the TLIF procedure in the ASC [ 9 , 10 , 11 ].…”

Ambulatory Lumbar Fusion

“…Blaginykh et al 19 investigated the NSQIP database and found that outpatient PLF patients were younger and less likely to be receiving steroid therapy, but were more likely to have high BMI and diabetes. Schlesinger et al 21 reported on ambulatory MIS-TLIF patients and found that they were younger, had fewer comorbidities, and had superior functional status. Kim26 reports similar findings for TLIF patients indicating those younger than 72, BMI <35, ASA class 2 or lower, preoperative ODI <50, with adequate home care, and no daily preoperative opioid use were selected for outpatient surgery.…”

“…The drains would be removed in the clinic setting at approximately one to five days postoperatively. 21 Parrish and colleagues perioperative plan included education/ counseling and administered 10 mg cyclobenzaprine, 150 mg pregabalin, and 10 mg oxycodone one hour preoperatively.…”

Emergency Department Visits After Outpatient Spine Surgery

“…[3][4][5][6][7][8][9][10][11][12] Outpatient spine surgery in particular has markedly grown in volume over the past decade. [13][14][15] A recent study by Lenke et al 16 examining the use of ASCs in the Medicare population found a 1780% increase in the volume of outpatient spinal surgeries from 2012 to 2017. This was more than 5 times higher than that of any other orthopedic specialty.…”