Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
Spine (Phila Pa 1976). 2022 Aug 15;47(16):1137-1144. doi: 10.1097/BRS.0000000000004380. Epub 2022 Jul 1.
Retrospective review of prospectively collected data.
To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF).
Assessing postoperative inefficiencies is vital to increase the feasibility of ALF.
Patients who underwent single-level minimally invasive transforaminal lumbar interbody fusion and would have met the eligibility criteria for ALF were included. Length of stay (LOS); time in postanesthesia recovery unit (PACU); alertness and neurological examination, and pain scores at three and six hours; type of analgesia; time to physical therapy (PT) visit; reasons for PT nonclearance; time to per-oral (PO) intake; time to voiding; time to readiness for discharge were assessed. Time taken to meet each discharge criterion was calculated. Multiple regression analyses were performed to study the effect of variables on postoperative parameters influencing discharge.
Of 71 patients, 4% were discharged on the same day and 69% on postoperative day 1. PT clearance was the last-met discharge criterion in 93%. Sixty-six percent did not get PT evaluation on the day of surgery. Seventy-six percent required intravenous opioids and <60% had adequate pain control. Twenty-six percent had orthostatic intolerance. The median postoperative LOS was 26.9 hours, time in PACU was 4.2 hours, time to PO intake was 6.5 hours, time to first void was 6.3 hours, time to first PT visit was 17.7 hours, time to PT clearance was 21.8 hours, and time to discharge readiness was 21.9 hours. Regression analysis showed that time to PT clearance, time to PO intake, time to voiding, time in PACU, and pain score at three hours had a significant effect on LOS.
Unavailability of PT, surgery after 1 pm , orthostatic intolerance, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge.
前瞻性数据回顾。
分析导致有资格行门诊腰椎融合术（ALF）的患者延迟出院的术后因素。
评估术后效率低下对于增加 ALF 的可行性至关重要。
纳入接受单节段微创经椎间孔腰椎体间融合术且符合 ALF 资格标准的患者。记录住院时间（LOS）、麻醉后恢复室（PACU）停留时间、清醒和神经检查、术后 3 小时和 6 小时的疼痛评分、镇痛类型、物理治疗（PT）就诊时间、PT 不通过的原因、经口（PO）摄入时间、排尿时间、准备出院时间。计算达到每个出院标准所需的时间。进行多元回归分析，以研究变量对影响出院的术后参数的影响。
71 例患者中，4%在术后当天出院，69%在术后第 1 天出院。PT 评估通过是最后达到的出院标准，占 93%。66%的患者在手术当天未接受 PT 评估。76%的患者需要静脉使用阿片类药物，<60%的患者疼痛控制良好。26%的患者有体位不耐受。术后 LOS 的中位数为 26.9 小时，PACU 停留时间为 4.2 小时，PO 摄入时间为 6.5 小时，首次排尿时间为 6.3 小时，首次 PT 就诊时间为 17.7 小时，PT 评估通过时间为 21.8 小时，准备出院时间为 21.9 小时。回归分析显示，PT 评估通过时间、PO 摄入时间、排尿时间、PACU 停留时间以及术后 3 小时的疼痛评分对 LOS 有显著影响。
PT 不可用、下午 1 点后手术、体位不耐受、疼痛控制不佳、PACU 停留时间延长以及进食和排尿时间延长被确定为阻止当天出院的可改变因素。
4 级。
