417 - MIS Lumbar Fusion in an Ambulatory Surgery Center (ASC): Safety, Treat...

#417 MIS Lumbar Fusion in an Ambulatory Surgery Center (ASC): Safety, Treatment Outcomes, and Comparison with Inpatient Lumbar Fusion

Oral Posters: Quality of Spine Care

Presented by: W. Smith

Author(s):

W.D. Smith (1), (2)
G.M. Christian (1)

(1) Western Regional Center for Brain & Spine Surgery, Neurosurgery, Las Vegas, NV, USA
(2) University Medical Center of Southern Nevada, Neurosurgery, Las Vegas, NV, USA

Abstract

Introduction: Outpatient facilities and ambulatory surgery centers (ASCs) are regularly utilized for procedures with low risk profiles, short ORT, and minimal needs for extended postoperative observation. The object of this work was to examine early safety and treatment outcomes following a mini-open lateral transpsoas approach for lumbar fusion performed at an ASC.

Methods: 54 consecutive patients were treated at an ASC with extreme lateral interbody fusion (XLIF). Retrospective chart review was performed to collect treatment (ORT, EBL, & LOS), complication, hospitalization, or ER visits data. Patients completed a post-discharge survey to assess general condition and pain. Mean age was 50.6 years, 31% were female, BMI was 28.3, 41% were smoked, and 39% had previous surgery. 80 total levels were treated from L1-S1.

Results: Mean ORT, EBL, and LOS were 86 mins, 71cc, and 5:46. No intraoperative complications were observed. Two (3.7%) hospitalizations occurred: One transfer for urinary retention and a second was admitted for uncontrolled pain following a three-level fusion. Two (3.7%) ER visits occurred, one for testicular pain, and the other for a fever on post-op day 2. No perioperative reoperations occurred.

Describing their condition an average of 4 days postoperative, 92% rated themselves as excellent (14.3%) or good (77.6%) and fair or poor in 8% (6.1% fair, 2% poor) of patients. Pain was none or slight in 67% of cases (8.3% none, 58.3% slight) while 25% reported moderate and 6.3% severe pain.

A concurrent series of 61 one-level XLIFs and 48 one-level ALIFs performed inpatient showed postoperative re-hospitalizations in 2.7% and 6.8% of cases, compared to 0% for the ASC one-level XLIFs.

Conclusions: Highly selected patients can safely be treated in ASCs with XLIF or other MIS approaches without increased hospitalizations or ER visits compared to those treated as inpatients. With ASCs receiving 65% to 70% of inpatient coding, this has the potential to both substantially decrease payer costs in select patients and procedures, while providing patients with a safe surgery and ability to spend the early postoperative period recovering at home.