Introduction: Increasing evidence suggests safety of outpatient lateral interbody fusion (LLIF). Recently, our institution adopted “same-day” discharge criteria for patients undergoing a single level LLIF. The purpose of this exploratory study was to demonstrate the feasibility and safety of same-day surgery for single level LLIF procedures.
Methods: Consecutive patients undergoing single level LLIF for a variety of indications were identified. Criteria for same day discharge were single level LLIF procedure without additional hardware, controlled post-operative pain and nausea, and no intra-operative complications. Patients being discharged “same day” (same as operative day) were identified retrospectively. Patients were analyzed for factors that may have contributed to outpatient versus inpatient hospital course.
Results: 9 patients were discharged same-day, while 5 were admitted for at least 22 hours. Average time until discharge for the same-day group was 2 hours and 41 minutes. Admitted patients were discharged on average 54.6 hours after admission. 10 criteria associated with the pre-operative and operative course were analyzed. Notable differences between the cohorts include shorter operative time in the same-day group (1.17 hours vs 0.9 hours, p=0.054), and lower BMI (33.48 vs 28.9, p=0.16). Within the inpatient cohort, 4 patients were admitted due to significant post-operative pain, with one patient having both significant pain and nausea requiring additional management. One patient was primarily admitted for lack of social support preventing same-day discharge. No patient experienced an adverse intra-operative or peri-operative complication.
Conclusions: Same-day discharge appears to be a feasible, safe, and effective approach for patients undergoing a single level lateral lumbar interbody fusion. While we were unable to determine any statistically significant pre-operative or intra-operative factor that may have contributed to patients requiring post-operative admission, we believe larger-scale analysis will be valuable in establishing criteria for planned outpatient LLIF and reducing surgical costs.
Patient Care: Given the current socioeconomic climate, cost reduction has become a crucial aspect of the management of spinal disease. If criteria are met, same day discharge provides a safe and cost-effective means of delivering care to select patients.
Learning Objectives: By the conclusion of this session, participants should be able to 1) understand the indications for single-level standalone lateral interbody fusion; 2) appreciate the differences between same day and outpatient surgery; 3) describe the criteria for same day discharge for single-level stand-alone LLIF; 4) be comfortable safely discharging single level standalone patients same day of surgery
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4. Smith WD, Wohns RN, Christian G, Rodgers EJ, Rodgers WB. Outpatient minimally invasive lumbar interbody: Fusion predictive factors and clinical results. Spine (Phila Pa 1976). 2016;41 Suppl 8:S106-22.