Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery

Shahi, Pratyush; Vaishnav, Avani S.; Melissaridou, Dimitra; Sivaganesan, Ahilan; Sarmiento, J. Manuel; Urakawa, Hikari; Araghi, Kasra; Shinn, Daniel; Song, Junho; Dalal, Sidhant; Iyer, Sravisht; Sheha, Evan; Dowdell, James; Qureshi, Sheeraz A.

doi:10.1097/brs.0000000000004380

Cited by 28 publications

(24 citation statements)

References 52 publications

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“…Revision surgeries were excluded. Surgeries included were performed as previously described in the literature [9][10][11][12][13][14][15][16][17] by fellowship-trained spine surgeons with practices dedicated to minimally invasive spine surgery.…”

Section: Study Design and Patient Cohortmentioning

confidence: 99%

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Shahi

Shinn

Singh

et al. 2022

Spine

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Study Design. Retrospective review of prospectively collected data. Objective. To determine the Oswestry Disability Index (ODI) cutoff for achieving Patient Acceptable Symptom State (PASS) at one year following minimally invasive lumbar spine surgery. Summary of Background Data. An absolute score denoting PASS, rather than a change score denoting minimal clinically important difference (MCID), might be a better metric to assess clinical outcomes. Materials and Methods. Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The outcome measure was ODI. The anchor question was the Global Rating Change. "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." For analysis, it was collapsed to a dichotomous outcome variable (acceptable = response of 1 or 2, unacceptable = response of 3, 4, or 5). Proportion of patients achieving PASS and the ODI cutoff using receiver operating characteristic curve analyses were assessed for the overall cohort as well as subgroups based on age, sex, type of surgery, and preoperative ODI. Differences between the PASS and MCID metrics were analyzed. Results. A total of 137 patients were included. In all, 87% of patients achieved PASS. Patients less than or equal to 65 years and those undergoing fusion were more likely to achieve PASS. The receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 to achieve PASS (area under the curve. 0.872, sensitivity: 82%, specificity: 83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area under the curve > 0.8 and ODI threshold values consistent between 25.2 and 25.5 (except 28.4 in patients with preoperative ODI > 40). PASS was found to have significantly higher sensitivity compared with MCID (82% vs. 69%, P = 0.01). Conclusions. Patients with ODI <25 are expected to achieve PASS, irrespective of age, sex, and preoperative disability. PASS was found to have significantly higher sensitivity than MCID.

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Section: Study Design and Patient Cohortmentioning

confidence: 99%

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Shahi

Shinn

Singh

et al. 2022

Spine

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“…This may pose another significant source of delay as unviability of PT has been shown to delay patient discharge. 37 As mentioned previously, this study is the first to comprehensively review PROs after outpatient/ambulatory lumbar fusion. Previous studies have focused only on complication rates.…”

Section: Literature Reviewmentioning

confidence: 92%

“…Proposed Patient Selection Criteria and Proposed Perioperative Protocol for Ambulatory Lumbar Fusion clinic regarding expectations immediately after surgery. 36,37 The patient must understand that they will not be completely pain-free at the time of discharge and that early and frequent ambulation will be expected.…”

Section: Literature Reviewmentioning

confidence: 99%

“…[38][39][40] It is critical to have explicit guidelines in the recovery room in order to set the patient on a path to speedy discharge while ensuring safety. Shahi et al, 37 summarized the necessary requirements for discharge, namely: neurological exam, physical therapy, void once, tolerate oral intake, and have adequate pain control without narcotics. The patient should be observed for no less than three hours, and they should be encouraged to ambulate once every hour if possible.…”

Section: Literature Reviewmentioning

confidence: 99%

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Ambulatory Lumbar Fusion

Subramanian

Araghi

Sivaganesan

et al. 2022

Spine

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Study Design/Setting. Systematic review. Objective. The primary purpose was to propose patient selection criteria and perioperative best practices that can serve as a starting point for an ambulatory lumbar fusion program. The secondary purpose was to review patient-reported outcomes (PROs) after ambulatory lumbar fusion. Summary of Background. As healthcare costs rise, there is an increasing emphasis on cost saving strategies (i.e. outpatient/ambulatory surgeries). Lumbar fusion procedures remain a largely inpatient surgery. Early studies have shown that fusion procedures can be safely preformed in an outpatient setting but no review has summarized these findings and best practices. Materials and Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, The Cochrane Library, and Embase were searched. The following data were collected: (1) study design; (2) number of participants; (3) patient population; (4) procedure types; (5) procedure setting; (6) inclusion criteria; (7) protocols; (8) adverse events; (9) PROs; and (10) associations between patient/surgical factors, setting, and outcomes. Results. The search yielded 20 publications. The following selection criteria for ambulatory lumbar fusion were identified: age below 70, minimal comorbidities, low/normal body mass index, no tobacco use, and no opioid use. The perioperative protocol can include a multimodal analgesic regimen. The patient should be observed for at least three hours after surgery. The patient should not be discharged without an alertness check and a neurological examination. Patients experienced significant improvements in PROs after ambulatory lumbar fusion; similarly, when compared to an inpatient group, ambulatory lumbar fusion patients experienced a comparable or superior improvement in PROs. Conclusion. There are two critical issues surrounding ambulatory lumbar fusion: (1) Who is the ideal patient, and (2) What needs to be done to enable expedited discharge? We believe this review will provide a foundation to assist surgeons in making decisions regarding the performance of lumbar fusion on an ambulatory basis. Level of Evidence. Level III.

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“…MI-TLIF was performed as previously described in the literature, [20][21][22][23][24][25][26][27] by using a tubular retractor with unilateral facetectomy, preparation of the disc space, interbody cage placement, and a bilateral percutaneous pedicle screw construct.…”

Section: Surgical Techniquementioning

confidence: 99%

Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

Shahi

Dalal

Shinn

et al. 2023

Neurosurgical Focus

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OBJECTIVE The goal of this study was to assess the outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients ≥ 70 years old and compare them to younger age groups. METHODS This was a retrospective study of data that were collected prospectively. Patients who underwent primary single-level MI-TLIF were included and divided into 3 groups: age < 60, 60–69, and ≥ 70 years. The outcome measures were as follows: 1) patient-reported outcome measures (PROMs) (i.e., visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]); 2) minimum clinically important difference (MCID) achievement; 3) return to activities; 4) opioid discontinuation; 5) fusion rates; and 6) complications/reoperations. RESULTS A total of 147 patients (age < 60 years, 62; 60–69 years, 47; ≥ 70 years, 38) were included. All the groups showed significant improvements in all PROMs at the early (< 6 months) and late (≥ 6 months) time points and there was no significant difference between the groups. Although MCID achievement rates for VAS leg and ODI were similar, they were lower in the ≥ 70-year-old patient group for VAS back and SF-12 PCS. Although the time to MCID achievement for ODI and SF-12 PCS was similar, it was greater in the ≥ 70-year-old patient group for VAS back and leg. There was no significant difference between the groups in terms of return to activities, opioid discontinuation, fusion rates, and complication/reoperation rates. CONCLUSIONS Although patients > 70 years of age may be less likely and/or take longer to achieve MCID compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.

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Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery

Cited by 28 publications

References 52 publications

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Ambulatory Lumbar Fusion

Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

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