Clinical studyEarly outcomes and safety of outpatient (surgery center) vs inpatient based L5-S1 Anterior Lumbar Interbody Fusion
Introduction
There has been an increasing movement toward cervical and lumbar surgery being performed in an ambulatory setting [9], [16], [30], [31], [37]. This trend is likely driven by newer minimally invasive techniques which often have the advantage of improved perioperative outcomes including operative time, estimated blood loss, and length of stay with no significant difference in patient-reported outcomes or complication rates [2], [10] An ambulatory surgery setting has the potential to build upon the benefits offered by MIS, including length of postoperative hospital stay and the associated direct and indirect costs without compromising patient safety or efficacy [11], [12], [13], [14], [18], [35], [39], [33].
Anterior Lumbar Interbody Fusion (ALIF) is a common operation used to treat a variety of pathologies with excellent outcomes [3], [5], [6], [15], [19], [21], [23], [24], [25], [27], [34], [36], [38]. While not traditionally considered in the context of MIS surgery, when done with an experienced vascular surgeon, utilizing a minimal anterior transverse incision, patients undergoing ALIF may see many of the benefits. To our knowledge there are no reports of outcomes of ALIF being performed in an ambulatory setting. We now seek to determine pain, safety, and secondary intervention, based outcomes of patients undergoing outpatient-based ALIF compared to a consecutive series of inpatient based ALIF performed during the same time period.
Section snippets
Materials and methods
Data was collected from consecutive patients treated by a total of 5 spine fellowship trained surgeons operating at the Indiana Spine Group from June 2015 to August 2017, beginning with the first outpatient ALIF performed in June 2015. Inclusion criteria were L5-S1 ALIF with or without posterior fixation. Diagnosis included degenerative disc disease (DDD), foraminal stenosis, recurrent disc herniation, pseudoarthrosis and isthmic spondylolisthesis. Patients were excluded for diagnosis other
Results
A total of 62 consecutive patients met the inclusion criteria and were available for review: 29 included in the Outpatient group and 33 included in the Inpatient group. There was no difference between groups with regard to sex (48.2% Female Outpatient, 60.6% Female Inpatient). The inpatient group was significantly older (44 vs 51 years of age; p = 0.01). The majority of patients underwent treatment for Degenerative Disc Disease (75.8% Outpatient, 90.9% Inpatient). All patients were ASA 1–2.
Discussion
Anterior Lumbar Interbody fusion is a common procedure to address multiple pathologies particularly at L5-S1 [21]. Fusion and outcomes following ALIF are typically as good if not better than posteriorly based procedures [6], [19], [24], [36], [38]. Advantages of ALIF include decreased adjacent segment degeneration [19], decreased morbidity, decreased blood loss, and shorted operative times [6], [15], [24], [34]. However, safety of ALIF necessitates navigating visceral and vascular structures.
Conclusion
In appropriately selected patients, outpatient ALIF is a safe and reproducible procedure with complication rates consistent with or lower than published rates. Patients outcome scores were no different in the inpatient versus outpatient group. Interestingly, there was a high number of secondary interventions performed in both inpatient and outpatient groups. Patients who underwent a secondary intervention did not get statistically significant improvement in VAS Back but, trended toward VAS leg
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Factors Affecting Postoperative Length of Stay in Patients Undergoing Anterior Lumbar Interbody Fusion
2021, World NeurosurgeryCitation Excerpt :Ambulatory surgical centers (ASCs) have become increasingly popular in recent years for certain spine procedures because of decreased overhead fees and avoidance of postoperative hospitalization.18,19 Given the short operative times and short recovery, there has been much interest in performing ALIFs in ASCs, with initial studies showing a low risk of complications when performed in this setting.20,21 However, as with any outpatient procedure, there is risk of needing hospitalization.
Venous anatomy of the lumbar region applied to anterior lumbar interbody fusion (ALIF): Proposal of a new classification
2021, North American Spine Society JournalCitation Excerpt :The main determinant of difficulty measurement was the iliac vein complex vascular anatomy dissection and none of these patients had any factors that could (pre operatively) alter these anatomic structures nor add more difficulty on their dissection. Although there is still controversy about whether the above techniques are better than posterior fixation techniques at the lumbar level, it is clear that ALIF is an efficient, safe technique with reproducible results [7,10,11]. Jiang et al. reported in their systematic review that clinical outcomes and failed fusion rates are similar between the two techniques (posterior and anterior), with radiological parameters (including disc height restoration, segmental and global lordosis) that are superior in the ALIF, nevertheless having a higher cost, bleeding and surgical time when compared to transforaminal interbody fusion [21].
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