Oral Posters: MIS
Presented by: A. Deukmedjian - View Audio/Video Presentation (Members Only)
A. Deukmedjian(1), E. Mason(1), A. Cianciabella(1)
(1) Deuk Spine Foundation, Melbourne, FL, United States
Objective: To report standard perioperative measures and patient outcomes following outpatient lumbar and cervical fusions (TLIF, ACDF, and PCDF) at an independent ASC.
Background data: Recent studies have highlighted the many potential benefits of outpatient spinal fusion surgery including reduced costs, increased efficiency, decreased complication rates and higher surgeon and patient satisfaction when compared to the hospital setting. Currently, there are no published studies emphasizing the safety and effectiveness of multi-level cervical and lumbar spinal fusion in an independent ASC.
Methods: Data was retrospectively reviewed for 79 consecutive patients that underwent outpatient lumbar and cervical spinal fusions at a single ASC from June 2014 - April 2016. Surgery type, estimated blood loss (EBL), levels fused, duration of anesthesia, surgical time, complications, and post-operative recovery time were recorded for all patients. In addition, patient outcomes were measured with both VAS scores for back/neck pain and percent resolution of preoperative axial and radicular symptoms.
Results: Mean patient age was 56 (range, 18-81) years. Male:female ratio was 3:2. The following surgeries were performed: TLIF 53 (67%), ACDF 18 (23%) and PCDF 8 (10%). Twelve single level and 67 multilevel fusions were performed for a total of 218 fused spinal segments. Lumbar fusions (TLIF) included 8 single level, 21 two level, 20 three level and 4 four level surgeries. Anterior cervical fusions (ACDF) included 4 single level, 9 two level, and 5 three level. Posterior cervical laminectomy and fusions (PCDF) included 1 six level and 7 seven level. EBL, surgical time, anesthesia times, and recovery times were recorded for all patients (Table 1). Pre/post-operative VAS scores for back/neck pain were obtained (n=75) with a mean follow-up time of 148 days. VAS scores improved from a mean pre-operative score of 8.9 ± 1.6 to a mean postoperative score of 1.3 ± 2.1 (p < 0.001). Confidence interval (99%) for VAS score reduction was found to be (6.1 - 7.4). Furthermore, there was no significant difference between single and multi-level fusion patient VAS score reductions (p=0.4). Mean percent resolutions for preoperative axial and radicular symptoms were found to be 90% (n=74) and 94% (n=75) respectively. All patients were discharged home the same day as their operation without complications. There were no emergency transfers, postoperative infections or hospital admissions within 24 hours.
Conclusions: Single and multi-level lumbar and cervical fusions can be performed safely, efficiently and effectively at an independent ASC. No significant difference in patient pain score outcomes was found between single and multi-level fusion patients.
Table 1. Outpatient Fusion Measured Variables]