Lateral Lumbar Interbody Fusion in Ambulatory Surgery Centers

Abstract

Study Design. Comparative analysis. Objective. To evaluate the safety and outcomes of moving lateral lumbar interbody fusion (LLIF) surgeries to an outpatient setting. Summary of Background Data. LLIF has been popularized as a less invasive lumbar fusion surgery as an alternative approach to anterior lumbar interbody fusions, posterior lateral interbody fusion, and transforaminal lateral interbody fusion (TLIF). Lumbar fusions have been traditionally performed in a hospital setting because of the potential blood loss, length of surgery, and need for longer recovery. There is a movement to transition spine surgeries to outpatient settings with many benefits afforded by less invasive techniques and technologies. Methods. The medical records of 70 consecutive patients with prospectively collected data were retrospectively reviewed. Two cohort groups, inpatients (40 patients) and outpatients (30 patients), were created. Patient demographics, risk factors, and body mass index (BMI) were evaluated to determine inclusion criteria for study. Result. A total of 34 males and 36 females, age range (31-71) average 59.3±2.3 years. Average BMI was 29.6±1.1kg/m 2. The most common level operated on being L3-L4 in both groups (63%). Mean preoperative inpatient Oswestry Disability Index (ODI) increased from 48.5±3.0 to 55.5±3.2 compared with outpatient preoperative ODI means reduced from 45.2±5.1 to 39.1±4.6. There was no statistically significant change in VAS scores between groups. There was however significant improvement in outpatient preoperative VAS scores from 7.3±0.5 to 4.1±0.5, P=0.045. Conclusion. The outcomes of the present study have shown that patients who had LLIF performed in the outpatient setting had statistically significant improvement in ODI scores compared with the inpatient setting (P=0.013). Fusion was achieved in all patients and there was no evidence of implant failure or subsidence. Complications were transient in both settings. We conclude that outpatient LLIF improves patients' outcomes with similar safety profile as the hospital setting. Level of Evidence: 3