CuÉllar Jason M, Wagner Willis, Rasouli Alexandre
Cedars-Sinai Spine Center.
Department of Orthopaedic Surgery.
Int J Spine Surg. 2020 Oct;14(5):687-693. doi: 10.14444/7100. Epub 2020 Oct 23.
As healthcare costs rise, attempts are being made to perform an increasing proportion of spine surgery in ambulatory surgery centers (ASCs). ASCs are more efficient, both economically and functionally. There remains uncertainty regarding the safety of performing anterior lumbar procedures requiring vascular access, as little has been published on this subset of patients.
This is a consecutive case series analysis of anterior lumbar spine surgeries that were performed in a free-standing ASC in a private-practice setting over a 1-year period, including anterior lumbar interbody fusion, artificial disc replacement, and hybrid procedures. The preoperative, intraoperative, and postoperative data recorded included age, gender, body mass index, tobacco use, and the presence of diabetes; level and procedure, operating room time, estimated blood loss, complications; discharge site, occurrence of reoperation, hospital admission, or any medical complication or infection over a 90-day period.
Fifty-one patients underwent 63 treated levels (34 artificial disc replacement, 29 anterior lumbar interbody fusion): 40 single-level, 10 two-level, one three-level. Average age was 45 years; 27 female, 24 males. None of the patients were diabetics, three were current smokers, seven were former smokers. Average body mass index was 27 ± 4 (range 16-36). Average total anesthesia time was 100 minutes (range 57-187 minutes). Average estimated blood loss was 23 mL (range 5-250 mL). Seventy-one percent of patients were discharged directly home, 29% to an aftercare facility. In the 30-day postoperative period there were no deaths, one hospital admission for pain, and no significant medical complications or surgical site infections.
In this consecutive case series artificial disc replacement or anterior lumbar interbody fusion was performed at 63 levels in 51 patients in the ASC setting with an observed major complication rate of zero and hospital unplanned admission rate of 2% (1/51). This provides some evidence that these procedures are safe to perform in the ASC setting. However, a highly experienced vascular surgeon and efficient surgical team, and strict patient selection criteria are all critical in making this possible.
随着医疗成本的上升，人们试图在门诊手术中心（ASC）进行越来越多比例的脊柱手术。ASC在经济和功能上都更高效。对于需要血管通路的前路腰椎手术的安全性仍存在不确定性，因为关于这部分患者的报道很少。
这是一项对在私人诊所环境下的独立ASC中进行的前路腰椎手术的连续病例系列分析，包括前路腰椎椎间融合术、人工椎间盘置换术和混合手术。记录的术前、术中和术后数据包括年龄、性别、体重指数、吸烟情况和糖尿病的存在；手术节段和术式、手术室时间、估计失血量、并发症；出院地点、再次手术的发生情况、住院情况或90天内的任何医疗并发症或感染情况。
51例患者接受了63个治疗节段（34例人工椎间盘置换术，29例前路腰椎椎间融合术）：40个单节段，10个双节段，1个三节段。平均年龄为45岁；女性27例，男性24例。患者均无糖尿病，3例为现吸烟者，7例为既往吸烟者。平均体重指数为27±4（范围16 - 36）。平均总麻醉时间为100分钟（范围57 - 187分钟）。平均估计失血量为23毫升（范围5 - 250毫升）。71%的患者直接出院回家，29%转至后续护理机构。术后30天内无死亡，1例因疼痛住院，无重大医疗并发症或手术部位感染。
在这个连续病例系列中，在ASC环境下对51例患者的63个节段进行了人工椎间盘置换术或前路腰椎椎间融合术，观察到的主要并发症发生率为零，医院意外住院率为2%（1/51）。这提供了一些证据表明这些手术在ASC环境下进行是安全的。然而，经验丰富的血管外科医生、高效的手术团队以及严格的患者选择标准对于实现这一点都至关重要。
