The Utility of Routinely Obtaining Postoperative Laboratory Studies Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

Ahn, Junyoung; Massel, Dustin H.; Mayo, Benjamin C.; Hijji, Fady Y.; Narain, Ankur S.; Aboushaala, Khaled; Bohl, Daniel D.; Elboghdady, Islam; DiBattista, Jacob V.; Singh, Kern

doi:10.1097/bsd.0000000000000459

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…Of the 31 articles, 26 articles specified the complications following MI-TLIF (Table 1). There were five articles that met inclusion criteria but did not report complications [35][36][37][38][39]. The most common complication cited after MI-TLIF surgery was radiculitis, with a range between rates of 2.8 and 57.1%.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

Weiss

García

Hopkins

et al. 2019

Curr Rev Musculoskelet Med

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Purpose of Review To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature. Recent Findings Current literature demonstrates that minimally invasive surgery (MIS) in spine has improved clinical outcomes and reduced complications when compared with open spinal procedures. Recent studies describing MI-TLIF primarily for degenerative disk disease, spondylolisthesis, and vertebral canal stenosis cite over 89 discrete complications, with the most common being radiculitis (ranging from 2.8 to 57.1%), screw malposition (0.3-12.7%), and incidental durotomy (0.3-8.6%). Summary Minimally invasive spine surgery has a distinct set of complications in comparison with other spinal procedures. These complications vary based on the exact MIS procedure and indication. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

Weiss

García

Hopkins

et al. 2019

Curr Rev Musculoskelet Med

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“…Although previous protocols in medical and surgical services have demonstrated success in reducing unnecessary laboratory testing, most interventions have been focused on increasing provider awareness, eliminating automatic order sets, and implementing universal guidelines. 2,5,8,9 Some programs implemented for high-risk patients in postoperative care units have attempted to consider adjusting ordering patterns based on patient comorbidities and clinical status, yet decision-making is typically based on provider opinion or consensus without a specific tool to risk stratify patients into appropriate laboratory testing tiers. [26][27][28] This study therefore represents a new implementation of predictive analytics to guide a laboratory costreducing protocol in a patient-centered model.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Multiple studies have demonstrated reduction in laboratory testing and associated costs after implementing protocols for different patient populations; however, these systems are almost universally applied to an entire cohort of patients without targeted risk assessment to determine a subset of patients who could appropriately receive a limited-laboratory protocol. 2,5,8,9 The explosion of predictive analytical tools for clinical outcomes has suggested its expansion to improve economic outcomes by associating patient risk with resource allocation. 10 Unfortunately, this application remains underexplored and specifically has not been applied to routine postoperative laboratory testing.…”

mentioning

confidence: 99%

Clinically Meaningful Laboratory Protocols Reduce Hospital Charges Based on Institutional and ACS-NSQIP® Risk Calculators in Hepatopancreatobiliary Surgery

Pickens

King

Barrier

et al. 2019

The American Surgeon™

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Postoperative laboratory testing is an underrecognized but substantial contributor to health-care costs. We aimed to develop and validate a clinically meaningful laboratory (CML) protocol with individual risk stratification using generalizable and institution-specific predictive analytics to reduce laboratory testing and maximize cost savings for low-risk patients. An institutionally based risk model was developed for pancreaticoduodenectomy and hepatectomy, and an ACS-NSQIP®–based model was developed for distal pancreatectomy. Patients were stratified in each model to the CML by individual risk of major complications, readmission, or death. Clinical outcomes and estimated cost savings were compared with those of a historical cohort with standard of care. Over 34 months, 394 patients stratified to the CML for pancreaticoduodenectomy or hepatectomy saved an estimated $803,391 (44.4%). Over 13 months, 52 patients stratified to the CML for distal pancreatectomy saved an estimated $81,259 (30.5%). Clinical outcomes for 30-day major complications, readmission, and mortality were unchanged after implementation of either model. Predictive analytics can target low-risk patients to reduce laboratory testing and improve cost savings, regardless of whether an institutional or a generalized risk model is implemented. Broader application is important in patient-centered health care and should transition from predictive to prescriptive analytics to guide individual care in real time.

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“…7 This is partly due to the perception that outpatient spine surgeries are less costly than similar inpatient procedures. 2,7 With the increasing scrutiny of health expenditures, the perceived cost savings and comparable outcomes to inpatient procedures have made outpatient spine procedures desirable for payers and surgeons. 3 Several studies have looked at patient selection and selected outcomes for specific spine surgical procedures, yet no review exists that examines the common patient selection factors and outcomes across the portfolio of outpatient spinal procedures.…”

mentioning

confidence: 99%

Does patient selection account for the perceived cost savings in outpatient spine surgery? A meta-analysis of current evidence and analysis from an administrative database

Mundell

Gates

Kerezoudis

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEFrom 1994 to 2006 outpatient spinal surgery increased 5-fold. The perceived cost savings with outcomes comparable to or better than those achieved with inpatient admission for the same procedures are desirable in an era where health expenditures are scrutinized. The increase in outpatient spine surgery is also driven by the proliferation of ambulatory surgery centers. In this study, the authors hypothesized that the total savings in outpatient spine surgery is largely driven by patient selection and biases toward healthier patients.METHODSA meta-analysis assessed patient selection factors and outcomes associated with outpatient spine procedures. Pooled odds ratios and mean differences were calculated using a Bayesian random-effects model. The authors extended this analysis in a novel way by using the results of the meta-analysis to examine cost data from an administrative database of academically affiliated hospitals. A Bayesian approach with priors informed by the meta-analysis was used to compare costs for inpatient and outpatient performance of anterior cervical discectomy and fusion (ACDF) and lumbar laminectomy.RESULTSSixteen studies with a total of 370,195 patients met the inclusion criteria. Outpatient procedures were associated with younger patient age (mean difference [MD] −2.34, 95% credible interval [CrI] −4.39 to −0.34) and no diabetes diagnosis (odds ratio [OR] 0.78, 95% CrI 0.54–0.97). Outpatient procedures were associated with a lower likelihood of reoperation (OR 0.42, 95% CrI 0.16–0.80), 30-day readmission (OR 0.39, 95% CrI 0.16–0.74), and complications (OR 0.29, 95% CrI 0.15–0.50) and with lower overall costs (MD −$121,392.72, 95% CrI −$216,824.81 to −$23,632.92). Additional analysis of the national administrative data revealed more modest cost savings than those found in the meta-analysis for outpatient spine surgeries relative to inpatient spine surgeries. Estimated cost savings for both younger patients ($555 for those age 30–35 years [95% CrI −$733 to −$374]) and older patients ($7290 for those age 65–70 years [95% CrI −$7380 to −$7190]) were less than the overall cost savings found in the meta-analysis.CONCLUSIONSCompared to inpatient spine surgery, outpatient spine surgery was associated with better short-term outcomes and an initial reduction in direct costs. A selection bias for outpatient procedures toward younger, healthier patients may confound these results. The additional analysis of the national database suggests that cost savings in the outpatient setting may be less than previously reported and a result of outpatient procedures being offered more frequently to younger and healthier individuals.

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The Utility of Routinely Obtaining Postoperative Laboratory Studies Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract: Level III.

Cited by 8 publications

References 15 publications

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

Clinically Meaningful Laboratory Protocols Reduce Hospital Charges Based on Institutional and ACS-NSQIP® Risk Calculators in Hepatopancreatobiliary Surgery

Does patient selection account for the perceived cost savings in outpatient spine surgery? A meta-analysis of current evidence and analysis from an administrative database

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