Prospective same day discharge instrumented lumbar spine surgery - a forty patient consecutive series

• Published in: European spine journal 2024-09, Vol.33 (9), p.3452-3456
• Main Authors: Boissiere, Louis, Haleem, Shahnawaz, Liquois, Frédéric, Aunoble, Stéphane, Cursolle, Jean-Christophe, Régnault de la Mothe, Gilles, Petit, Marion, Pellet, Nicolas, Bourghli, Anouar, Larrieu, Daniel, Obeid, Ibrahim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Ambulatory Surgical Procedures - methods; Analgesia; Back surgery; Bone surgery; Complications; Decompression; Feasibility studies; Female; Hematoma; Humans; Lumbar Vertebrae - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Pain; Patient Discharge - statistics & numerical data; Patient satisfaction; Postoperative; Postoperative Complications - epidemiology; Prospective Studies; Spinal Fusion - methods; Spine (lumbar); Surgical Orthopedics; Young Adult
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08365-9

Purpose Outpatient lumbar decompression surgeries have been successfully performed in France for over twenty years, earning acceptance. However, outpatient instrumented lumbar spine procedures and arthroplasties are less documented. This study aimed to evaluate the feasibility, efficiency, and safety of outpatient lumbar instrumented surgery. Methods A prospective single-center study involving three experienced surgeons was conducted from September 2020 to September 2021, with a minimum six-month postoperative follow-up. Inclusion criteria comprised patients aged 18 to 75 eligible for same-day discharge, undergoing single-level lumbar spinal fusion or arthroplasty via anterior or posterior Wiltse approach. The primary endpoint was assessing the percentage of successful outpatient discharges (within twelve hours), with secondary endpoints including perioperative/postoperative complications and discharge pain prescriptions in terms of frequency and severity. Results Forty patients (mean age: 44 years; 16/24 male/female ratio) underwent surgery, including 18 lumbar arthroplasties, twelve ALIF, and ten TLIF procedures. The majority of surgeries were performed at L4-L5 (18 procedures) and L5-S1 levels (22 procedures). 95% (38/40) of patients were successfully discharged within twelve hours, with only two patients discharged the following day. No postoperative hematomas, serious adverse events, or revision surgeries were noted. Conclusion 95% of patients were discharged successfully within twelve hours following outpatient lumbar fusion surgery, with a 100% patient satisfaction rate. Specific technical solutions were not necessary, and oral pain relief sufficed. Patient selection and education, including early pain management, played crucial roles in complication avoidance. This study underscores the safety of outpatient instrumented lumbar spine procedures, leading to cost reduction and expedited recovery.