The Safety of Minimally Invasive Transforminal Interbody Fusion as an Outpatient Procedure

Presented at SMISS Annual Forum 2014
By Sina Pourtaheri MD
With Arash Emami MD, Eiman Shafa MD, Sujal Patel MD, Ki Hwang MD, Michael Faloon MD, Kimona Issa MD, Kumar Sinha MD,

Disclosures: Sina Pourtaheri MD None Arash Emami MD B; Depuy Spine, Eiman Shafa MD None, Sujal Patel MD None, Ki Hwang MD B; Depuy Spine, Michael Faloon MD None, Kimona Issa MD None, Kumar Sinha MD None,

Introduction:
Minimally invasive transforaminal lumbar interbody fusions (MIS-TLIFs) as compared to open TLIFs has shown similar long-term clinical outcomes with decreased perioperative morbidity and earlier return to work. However, the safety of preforming MIS-TLIFs as an outpatient procedure has not been reported in the literature.

Aims/Objectives:
The purpose of this study is to see if this procedure can be safely performed as an outpatient surgery without requiring postoperatively a hospital admission.

Methods:
We retrospectively reviewed 98 consecutive patients undergoing one or two-level MIS-TLIFs. Our study included revision (21%) and primary (79%) procedures. All patients had a minimum of two year clinical and radiographic follow-up. Group 1 was outpatient procedures (36%) and Group 2 was inpatient procedures. It was surgeon’s decision based off the patient’s medical comorbidities to perform the surgery as an outpatient. Early postoperative complications and readmissions were identified. Chi-squared statistic, Fisher’s exact, and single sample t tests were used.

Results:
There were no statistically significant differences in overall postoperative complication rates, ODIs, or VAS scores between the study groups (p < 0.05). The outpatient cohort had fewer complications (9% vs. 17%), however not statistically significant. The outpatient cohort required no readmissions, while the inpatient cohort had 7 readmissions (p < 0.04). The outpatient cohort had lower Charleston comorbidity index scores (0.69 vs. 1.39 points, p < 0.05), however were similar in age (47 vs. 51 years, p < 0.88).

Conclusions:
MIS-TLIF can safely be performed as an outpatient in patients with minimal medical comorbidities. As an outpatient procedure, postoperative clinical outcomes were similar to the inpatient ones with an acceptable complication rate.