门诊手术中心的腰椎侧方椎间融合术：与住院队列相比的患者选择和结果指标
Lateral Lumbar Interbody Fusion in Ambulatory Surgery Centers: Patient Selection and Outcome Measures Compared With an Inhospital Cohort.
作者信息
Chin Kingsley R, Pencle Fabio J R, Coombs André V, Brown Morgan D, Conklin Kasey J, O'Neill Andew M, McGarry Michael J, Seale Jason A, Hothem Elijah A
机构信息
*Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431†Less Exposure Surgery Specialists Institutes (LESSi), 1100 W. Oakland Park Blvd, Ste#3, Fort Lauderdale, FL, 33311‡Less Exposure Suregery(LES) Society, 3217 NW 10th Terrace, Ste 307, Fort Lauderdale, Fl 33309§University of Florida, Gainesville, FL 32611.
出版信息
Spine (Phila Pa 1976). 2016 Apr;41(8):686-92. doi: 10.1097/BRS.0000000000001285.
STUDY DESIGN
Comparative analysis.
OBJECTIVE
To evaluate the safety and outcomes of moving lateral lumbar interbody fusion (LLIF) surgeries to an outpatient setting.
SUMMARY OF BACKGROUND DATA
LLIF has been popularized as a less invasive lumbar fusion surgery as an alternative approach to anterior lumbar interbody fusions, posterior lateral interbody fusion, and transforaminal lateral interbody fusion (TLIF). Lumbar fusions have been traditionally performed in a hospital setting because of the potential blood loss, length of surgery, and need for longer recovery. There is a movement to transition spine surgeries to outpatient settings with many benefits afforded by less invasive techniques and technologies.
METHODS
The medical records of 70 consecutive patients with prospectively collected data were retrospectively reviewed. Two cohort groups, inpatients (40 patients) and outpatients (30 patients), were created. Patient demographics, risk factors, and body mass index (BMI) were evaluated to determine inclusion criteria for study.
RESULT
A total of 34 males and 36 females, age range (31-71) average 59.3 ± 2.3 years. Average BMI was 29.6 ± 1.1 kg/m. The most common level operated on being L3-L4 in both groups (63%). Mean preoperative inpatient Oswestry Disability Index (ODI) increased from 48.5 ± 3.0 to 55.5 ± 3.2 compared with outpatient preoperative ODI means reduced from 45.2 ± 5.1 to 39.1 ± 4.6. There was no statistically significant change in VAS scores between groups. There was however significant improvement in outpatient preoperative VAS scores from 7.3 ± 0.5 to 4.1 ± 0.5, P = 0.045.
CONCLUSION
The outcomes of the present study have shown that patients who had LLIF performed in the outpatient setting had statistically significant improvement in ODI scores compared with the inpatient setting (P = 0.013). Fusion was achieved in all patients and there was no evidence of implant failure or subsidence. Complications were transient in both settings. We conclude that outpatient LLIF improves patients' outcomes with similar safety profile as the hospital setting.
LEVEL OF EVIDENCE
研究设计
对比分析。
目的
评估将腰椎侧方椎间融合术（LLIF）手术转移至门诊环境的安全性及手术效果。
背景数据总结
LLIF作为一种侵入性较小的腰椎融合手术已得到推广，可作为前路腰椎椎间融合术、后侧方椎间融合术及经椎间孔腰椎椎间融合术（TLIF）的替代方法。由于存在潜在失血、手术时长及需要更长恢复时间等因素，传统上腰椎融合手术在医院环境中进行。目前有一种趋势是将脊柱手术转移至门诊环境，微创技术和科技带来了诸多益处。
方法
对70例连续患者的病历进行回顾性分析，这些患者的数据是前瞻性收集的。创建了两个队列组，即住院患者组（40例）和门诊患者组（30例）。评估患者的人口统计学数据、风险因素及体重指数（BMI）以确定研究的纳入标准。
结果
共70例患者，其中男性34例，女性36例，年龄范围为31 - 71岁，平均年龄59.3±2.3岁。平均BMI为29.6±1.1kg/m²。两组中最常进行手术的节段均为L3 - L4（63%）。住院患者术前Oswestry功能障碍指数（ODI）平均从48.5±3.0增加到55.5±3.2，而门诊患者术前ODI平均从45.2±5.1降至39.1±4.6。两组间视觉模拟评分（VAS）无统计学显著变化。然而，门诊患者术前VAS评分从7.3±0.5显著改善至4.1±0.5，P = 0.045。
结论
本研究结果表明，与住院环境相比，在门诊环境中接受LLIF手术的患者ODI评分有统计学显著改善（P = 0.013）。所有患者均实现融合，且无植入物失败或下沉的证据。两种环境下的并发症均为短暂性。我们得出结论，门诊LLIF可改善患者手术效果，且安全性与医院环境相似。
证据级别
3级。
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