A new study published in Spine examines outpatient spine surgery in ambulatory surgery centers.
The study authors, including William D. Smith, MD, Richard N. Wohns, MD, MBA, and W. Blake Rodgers, MD, examined lumbar spinal fusions in the outpatient setting. They examined the predictors of early postoperative discharge and tested the predictive model against two clinical series of outpatient minimally invasive lumbar fusion patients, according to the study.
There were 1,033 patients treated with minimally invasive lateral interbody fusion grouped according to the length of postoperative hospitalization; 873 patients were discharged in less than 24 hours and 160 were discharged after 24 hours or more. In the clinical studies, there were 54 consecutive XLIF patients and 18 consecutive minimally invasive posterior fusion patients treated in an ASC.
The researchers found:
1. The strongest baseline predictors for early discharge were:
• Less advanced diagnosis
• Younger patients
• Elevated baseline hemoglobin levels
• Lower body mass index
2. The variables that were most predictive of early discharge were elevated postoperative hemoglobin levels and fewer levels treated.
3. The outpatient surgeries performed in the clinical series were for younger patients and relatively few levels — 96 percent were one- or two-level cases.
4. There weren't any intraoperative complications among the clinical series outpatient cases. There were few postoperative complications in the XLIF and the minimally invasive posterior fusion procedures.
5. There weren't any emergent transfers to the inpatient facilities.
"Select patients, by health and indication, can safely be treated as outpatients with XLIF or other modern MIS approaches," concluded the study authors.