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Boissiere L, Haleem S, Liquois F, Aunoble S, Cursolle JC, Régnault de la Mothe G, Petit M, Pellet N, Bourghli A, Larrieu D, Obeid I. Prospective same day discharge instrumented lumbar spine surgery - a forty patient consecutive series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08365-9. [PMID: 38918227 DOI: 10.1007/s00586-024-08365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Outpatient lumbar decompression surgeries have been successfully performed in France for over twenty years, earning acceptance. However, outpatient instrumented lumbar spine procedures and arthroplasties are less documented. This study aimed to evaluate the feasibility, efficiency, and safety of outpatient lumbar instrumented surgery. METHODS A prospective single-center study involving three experienced surgeons was conducted from September 2020 to September 2021, with a minimum six-month postoperative follow-up. Inclusion criteria comprised patients aged 18 to 75 eligible for same-day discharge, undergoing single-level lumbar spinal fusion or arthroplasty via anterior or posterior Wiltse approach. The primary endpoint was assessing the percentage of successful outpatient discharges (within twelve hours), with secondary endpoints including perioperative/postoperative complications and discharge pain prescriptions in terms of frequency and severity. RESULTS Forty patients (mean age: 44 years; 16/24 male/female ratio) underwent surgery, including 18 lumbar arthroplasties, twelve ALIF, and ten TLIF procedures. The majority of surgeries were performed at L4-L5 (18 procedures) and L5-S1 levels (22 procedures). 95% (38/40) of patients were successfully discharged within twelve hours, with only two patients discharged the following day. No postoperative hematomas, serious adverse events, or revision surgeries were noted. CONCLUSION 95% of patients were discharged successfully within twelve hours following outpatient lumbar fusion surgery, with a 100% patient satisfaction rate. Specific technical solutions were not necessary, and oral pain relief sufficed. Patient selection and education, including early pain management, played crucial roles in complication avoidance. This study underscores the safety of outpatient instrumented lumbar spine procedures, leading to cost reduction and expedited recovery.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France.
| | - Shahnawaz Haleem
- Royal Orthopaedic Hospital, Spinal House, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - Frédéric Liquois
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Stéphane Aunoble
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | | | | | - Marion Petit
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Nicolas Pellet
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 avenue Maryse Bastié, Bruges, 33520, France
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Mummareddy N, Ahluwalia R, Zuckerman SL, Lakomkin N, Asher A, Devin CJ. Identifying the most appropriate lumbar decompression patients for ambulatory surgery centers - A pilot study using inpatient and outpatient hospital data. J Clin Neurosci 2019; 72:206-210. [PMID: 31859177 DOI: 10.1016/j.jocn.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To minimize healthcare related costs, ambulatory surgery centers (ASCs) have become increasingly favored venues for outpatient spine surgery. Using a national cohort of patients undergoing elective lumbar decompression (LD) in an inpatient or outpatient hospital setting, the current objectives were to: 1) outline specific factors that were associated with complications, and 2) describe potentially catastrophic complications. METHODS Adults who underwent LD between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Inclusion criteria were: principal procedure LD (CPT 63030), elective, neurologic/orthopaedic surgeons, length of stay (LOS) of 0/1 days, and discharged home. The primary outcome was presence of any complication. The secondary outcome was occurrence of potentially catastrophic complications. Univariate/multivariable logistic regression was performed. RESULTS A total of 19,908 patients met the inclusion criteria. 564 (2.83%) patients experienced a complication. Cardiac intervention remained the only independent predictor of complications after multivariate testing (OR: 2.02, 95% CI: 1.00, 4.07, p = 0.049). Approximate comorbidity score cut-offs associated with <2% risk of complication were: ASA ≤ 3, CCI ≤ 5, mFI ≤ 0.182. A total of 96 (0.48%) patients experienced potentially catastrophic complications. CONCLUSIONS We utilized a national cohort of patients undergoing elective inpatient and outpatient LD in a hospital setting to identify preoperative risk factors for postoperative complications. Previous cardiac intervention was the sole independent predictor of complications. Although no patients treated at ASCs were studied, we believe these factors can aid in selecting patients most appropriate for ASCs and begin the process of selecting the best patients for an ambulatory setting.
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Affiliation(s)
- Nishit Mummareddy
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anthony Asher
- Charlotte Neurosurgical Associates, Charlotte, NC, United States
| | - Clinton J Devin
- Orthopaedic of Steamboat Springs, Steamboat Springs, CO, United States
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