Villavicencio Alan T, Nelson Ewell Lee, Mason Alexander, Rajpal Sharad, Burneikiene Sigita
Boulder Neurosurgical Associates, Boulder, CO 80304, USA.
J Spinal Disord Tech. 2013 Aug;26(6):298-304. doi: 10.1097/BSD.0b013e318246aea2.
A retrospective chart review study was performed.
The primary objective of this study was to analyze our preliminary results to examine whether it is safe and effective to perform instrumented lumbar interbody fusions on an outpatient basis by comparing 2 groups of patients who were discharged the same day versus those who stayed overnight. The secondary objective was to identify the need for prolonged observation for complications that may occur in the immediate postoperative period.
There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting.
Surgeries were performed at an ambulatory surgery center (n=27) or hospital outpatient departments (n=25). The mean age of patients was 49.8 years (range, 19-72 y). The safety of outpatient lumbar fusions was assessed by analyzing complications that occurred from the moment of discharge up to the seventh postoperative day (0-7 POD), as well as all complications that occurred up to 6 months postoperatively (>7 POD). The efficacy of surgical intervention was also evaluated by assessing change in pain, patient satisfaction scores, and fusion rates.
There were no cases of pneumonia, urinary tract infection, or thromboembolic complications. Four patients (14%) who had surgeries performed at an ambulatory surgery center had complications within 7 days postoperatively compared with 1 (4%) patient who had surgery performed at a hospital outpatient department. This difference was not statistically significant (P=0.36, Fisher exact test). Lower back and leg pain was significantly (P<0.0001) decreased postoperatively. The average postoperative back pain was 18.8 (range, 0-90) compared with 74.5 (range, 0-100) preoperatively as measured on a 0-100 visual analog scale. The average postoperative leg pain was 9.1 (range, 0-60) compared with 54.2 (range, 0-100) preoperatively.
Although further confirmation is needed, this study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure. These results support a future prospective randomized study with a well-defined patient selection criteria.
进行了一项回顾性病历审查研究。
本研究的主要目的是分析我们的初步结果，通过比较两组同日出院患者与过夜留院患者，来检验门诊进行器械辅助腰椎椎间融合术是否安全有效。次要目的是确定对于术后早期可能出现的并发症是否需要延长观察时间。
目前文献中尚无关于在门诊手术环境中进行器械辅助经椎间孔腰椎椎间融合术的安全性和并发症发生率的信息。
手术在门诊手术中心（n = 27）或医院门诊部（n = 25）进行。患者的平均年龄为49.8岁（范围19 - 72岁）。通过分析出院后至术后第7天（0 - 7术后日）发生的并发症以及术后6个月内（>7术后日）发生的所有并发症来评估门诊腰椎融合术的安全性。还通过评估疼痛变化、患者满意度评分和融合率来评估手术干预的疗效。
未发生肺炎、尿路感染或血栓栓塞并发症。在门诊手术中心接受手术的4例患者（14%）在术后7天内出现并发症，而在医院门诊部接受手术的患者有1例（4%）出现并发症。这种差异无统计学意义（P = 0.36，Fisher精确检验）。术后腰腿痛明显减轻（P < 0.0001）。在0 - 100视觉模拟量表上测量，术后平均背痛为18.8（范围0 - 90），术前为74.5（范围0 - 100）。术后平均腿痛为9.1（范围0 - 60），术前为54.2（范围0 - 100）。
尽管需要进一步证实，但本研究讨论了采用经椎间孔腰椎椎间融合技术门诊进行器械辅助腰椎椎间融合术的可能性。这些结果支持未来进行一项有明确患者选择标准的前瞻性随机研究。
