Parrish James M, Jenkins Nathaniel W, Nolte Michael T, Massel Dustin H, Hrynewycz Nadia M, Brundage Thomas S, Myers Jonathan A, Singh Kern
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
2Department of Orthopaedics, Miller School of Medicine, University of Miami, Florida; and.
J Neurosurg Spine. 2020 May 22;33(4):446-454. doi: 10.3171/2020.3.SPINE20134. Print 2020 Oct 1.
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.
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.
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).
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.
虽然前路腰椎椎间融合术（ALIF）可能适用于门诊手术，但据推测，诸如术后肠梗阻和血管并发症风险等限制因素阻碍了该手术向门诊环境的转变。识别使患者在ALIF术后住院≥24小时的独立危险因素，可能有助于改善术后结果，针对可改变的危险因素，并协助开发筛查工具，以便将合适的患者转至门诊手术中心（ASC）进行该手术。本研究的目的是确定使患者在ALIF术后易发生≥24小时住院的最相关危险因素。
回顾了2006年5月至2019年12月期间接受单节段ALIF手术患者的前瞻性维护手术登记册。根据患者住院≥24小时的相对风险（RR）升高情况，评估人口统计学、术前诊断、围手术期变量和术后并发症。使用泊松回归模型评估住院≥24小时的预测因素。通过逐步向后回归模型确定住院≥24小时的危险因素。
共有111例患者接受了单节段ALIF手术（女性占50.9%，男性占52.6%，年龄≤50岁）。11例（9.5%）患者在<24小时内出院，116例患者仍住院≥24小时。平均住院时间>2天（53.7小时）。最常见的术后并发症是发热（体温≥100.4°F；n = 4，3.5%）和输血（n = 4，3.5%）。二元分析显示，术前诊断为椎体后滑脱或侧方滑脱会使住院≥24小时的RR升高（两种诊断的RR均为1.11，p = 0.001）。逐步多变量分析表明，住院≥24小时的显著预测因素为L4-5节段手术、并存的退行性椎间盘疾病（DDD）伴椎间孔狭窄和髓核突出（RR 1.11，95%CI 1.03-1.20，p = 0.009，所有协变量）。
本研究提供了有关接受单节段ALIF手术患者的人口统计学、围手术期特征和术后并发症发生率的数据。这项初步调查确定了在将ALIF手术适当地转至ASC之前需要考虑的最相关危险因素。需要进一步研究术前特征以阐明理想的ASC-ALIF患者。
