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Preliminary Results on Feasibility of Outpatient Instrumented Transforaminal Lumbar Interbody Fusion

Villavicencio, Alan T. MD; Nelson, Ewell Lee MD; Mason, Alexander MD; Rajpal, Sharad MD; Burneikiene, Sigita MD

Journal of Spinal Disorders and Techniques: August 2013 - Volume 26 - Issue 6 - p 298–304
doi: 10.1097/BSD.0b013e318246aea2
ORIGINAL ARTICLES
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Study Design: A retrospective chart review study was performed.

Objective: The primary objective of this study was to analyze our preliminary results to examine whether it is safe and effective to perform instrumented lumbar interbody fusions on an outpatient basis by comparing 2 groups of patients who were discharged the same day versus those who stayed overnight. The secondary objective was to identify the need for prolonged observation for complications that may occur in the immediate postoperative period.

Summary of Background Data: There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting.

Methods: Surgeries were performed at an ambulatory surgery center (n=27) or hospital outpatient departments (n=25). The mean age of patients was 49.8 years (range, 19–72 y). The safety of outpatient lumbar fusions was assessed by analyzing complications that occurred from the moment of discharge up to the seventh postoperative day (0–7 POD), as well as all complications that occurred up to 6 months postoperatively (>7 POD). The efficacy of surgical intervention was also evaluated by assessing change in pain, patient satisfaction scores, and fusion rates.

Results: There were no cases of pneumonia, urinary tract infection, or thromboembolic complications. Four patients (14%) who had surgeries performed at an ambulatory surgery center had complications within 7 days postoperatively compared with 1 (4%) patient who had surgery performed at a hospital outpatient department. This difference was not statistically significant (P=0.36, Fisher exact test). Lower back and leg pain was significantly (P<0.0001) decreased postoperatively. The average postoperative back pain was 18.8 (range, 0–90) compared with 74.5 (range, 0–100) preoperatively as measured on a 0–100 visual analog scale. The average postoperative leg pain was 9.1 (range, 0–60) compared with 54.2 (range, 0–100) preoperatively.

Conclusions: Although further confirmation is needed, this study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure. These results support a future prospective randomized study with a well-defined patient selection criteria.

*Boulder Neurosurgical Associates

Justin Parker Neurological Institute, Boulder, CO

No funding was received for this work from any of the organizations and none of the authors or their family members have received financial benefits from any commercial party for the production of this manuscript. Drs Villavicencio and Nelson are stockholders at Lanx.

Reprints: Sigita Burneikiene, MD, Boulder Neurosurgical Associates, 1155 Alpine Ave, Suite 320 Boulder, CO 80304 (e-mail: sigitab@bnasurg.com).

Received March 21, 2011

Accepted December 14, 2011

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.