Predictors of inpatient admission in the setting of anterior lumbar interbody fusion: a Minimally Invasive Spine Study Group (MISSG) investigation

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  • 1 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois;
  • 2 Department of Orthopaedics, Miller School of Medicine, University of Miami, Florida; and
  • 3 Department of Surgery, Rush University Medical Center, Chicago, Illinois
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OBJECTIVE

While the anterior lumbar interbody fusion (ALIF) procedure may be amenable to ambulatory surgery, it has been hypothesized that limitations such as the risk of postoperative ileus and vascular complications have hindered transition of this procedure to the outpatient setting. Identification of independent risk factors predisposing patients to inpatient stays of ≥ 24 hours after ALIF may facilitate better postsurgical outcomes, target modifiable risk factors, and assist in the development of screening tools to transition appropriate patients to the ambulatory surgery center (ASC) setting for this procedure. The purpose of this study was to identify the most relevant risk factors that predispose patients to ≥ 24-hour admission following ALIF.

METHODS

A prospectively maintained surgical registry was reviewed for patients undergoing single ALIF between May 2006 and December 2019. Demographics, preoperative diagnosis, perioperative variables, and postoperative complications were evaluated according to their relative risk (RR) elevation for an inpatient stay of ≥ 24 hours. A Poisson regression model was used to evaluate predictors of inpatient stays of ≥ 24 hours. Risk factors for inpatient admission of ≥ 24 hours were identified with a stepwise backward regression model.

RESULTS

A total of 111 patients underwent single-level ALIF (50.9% female and 52.6% male, ≤ 50 years old). Eleven (9.5%) patients were discharged in < 24 hours and 116 remained admitted for ≥ 24 hours. The average inpatient stay was > 2 days (53.7 hours). The most common postoperative complications were fever (body temperature ≥ 100.4°F; n = 4, 3.5%) and blood transfusions (n = 4, 3.5%). Bivariate analysis revealed a preoperative diagnosis of retrolisthesis or lateral listhesis to elevate the RR for an inpatient stay of ≥ 24 hours (RR 1.11, p = 0.001, both diagnoses). Stepwise multivariate analysis demonstrated significant predictors for inpatient stays of ≥ 24 hours to be an operation on L4–5, coexisting degenerative disc disease (DDD) with foraminal stenosis, and herniated nucleus pulposus (RR 1.11, 95% CI 1.03–1.20, p = 0.009, all covariates).

CONCLUSIONS

This study provides data regarding the incidence of demographic and perioperative characteristics and postoperative complications as they pertain to patients undergoing single-level ALIF. This preliminary investigation identified the most relevant risk factors to be considered before appropriately transitioning ALIF procedures to the ASC. Further studies of preoperative characteristics are needed to elucidate ideal ASC ALIF patients.

ABBREVIATIONS ALIF = anterior lumbar interbody fusion; ASA = American Society of Anesthesiologists; ASC = ambulatory surgery center; CCI = Charlson Comorbidity Index; DDD = degenerative disc disease; DSD = degenerative spine disease; EBL = estimated blood loss; LLIF = lateral lumbar interbody fusion; PLIF = posterior lumbar interbody fusion; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale.

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Contributor Notes

Correspondence Kern Singh: Rush University Medical Center, Chicago, IL. kern.singh@rushortho.com.

INCLUDE WHEN CITING Published online May 22, 2020; DOI: 10.3171/2020.3.SPINE20134.

Disclosures Dr. Singh reports receiving royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, and Slack Publishing; direct stock ownership in Avaz Surgical LLC and Vital 5 LLC; being a consultant for Zimmer Biomet and K2M; board membership in Vital 5 LLC, TDi LLC, and the Minimally Invasive Spine Study Group; editorial board membership in Contemporary Spine Surgery, Orthopedics Today, and Vertebral Columns; board of directors membership in CSRS, ISASS, and AAOS; and receiving a grant from the Cervical Spine Research Society.

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