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  • Implementation of Discharge Criteria Facilitates Same-Day Discharge After Single-Level Lateral Interbody Fusion

    Final Number:

    Arpan A Patel BS; Jakub Godzik MD MSc; Corey Tyler Walker MD; Cory Hartman MD, MBA; Jay D. Turner MD, PhD; Juan S. Uribe MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    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

    References: 1. Ahmadian A, Bach K, Bolinger B, et al. Stand-alone minimally invasive lateral lumbar interbody fusion: Multicenter clinical outcomes. J Clin Neurosci. 2015;22(4):740-746. 2. Chin KR, Pencle FJ, Coombs AV, et al. Lateral lumbar interbody fusion in ambulatory surgery centers: Patient selection and outcome measures compared with an inhospital cohort. Spine (Phila Pa 1976). 2016;41(8):686-692. 3. Sivaganesan A, Hirsch B, Phillips FM, McGirt MJ. Spine surgery in the ambulatory surgery center setting: Value-based advancement or safety liability? Neurosurgery. 2018. 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.

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