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. 2023 Feb 15;48(4):278-287.
doi: 10.1097/BRS.0000000000004519. Epub 2022 Nov 4.

Ambulatory Lumbar Fusion: A Systematic Review of Perioperative Protocols, Patient Selection Criteria, and Outcomes

Tejas Subramanian  1   2 , Kasra Araghi  1 , Ahilan Sivaganesan  1 , Pratyush Shahi  1 , Avani Vaishnav  1 , Sravisht Iyer  1 , Sheeraz A Qureshi  1
Affiliations

Ambulatory Lumbar Fusion: A Systematic Review of Perioperative Protocols, Patient Selection Criteria, and Outcomes

Tejas Subramanian et al. Spine (Phila Pa 1976). .

Abstract

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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Conflict of interest statement

The authors report no conflicts of interest.

References

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    1. Mundell BF, Gates MJ, Kerezoudis P, et al. 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: presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves. J Neurosurg Spine. 2018;29:687–95.
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    1. Arshi A, Park HY, Blumstein GW, et al. Outpatient posterior lumbar fusion: a population-based analysis of trends and complication rates. Spine. 2018;43:1559–65.

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