Hospital for Special Surgery, New York, NY.
Weill Cornell Medicine, New York, NY.
Spine (Phila Pa 1976). 2023 Feb 15;48(4):278-287. doi: 10.1097/BRS.0000000000004519. Epub 2022 Nov 4.
STUDY DESIGN/SETTING: Systematic review.
The primary purpose was to propose patient selection criteria and perioperative best practices that can serve as a starting point for an ambulatory lumbar fusion program. The secondary purpose was to review patient-reported outcomes (PROs) after ambulatory lumbar fusion.
As healthcare costs rise, there is an increasing emphasis on cost saving strategies (i.e. outpatient/ambulatory surgeries). Lumbar fusion procedures remain a largely inpatient surgery. Early studies have shown that fusion procedures can be safely preformed in an outpatient setting but no review has summarized these findings and best practices.
This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, The Cochrane Library, and Embase were searched. The following data were collected: (1) study design; (2) number of participants; (3) patient population; (4) procedure types; (5) procedure setting; (6) inclusion criteria; (7) protocols; (8) adverse events; (9) PROs; and (10) associations between patient/surgical factors, setting, and outcomes.
The search yielded 20 publications. The following selection criteria for ambulatory lumbar fusion were identified: age below 70, minimal comorbidities, low/normal body mass index, no tobacco use, and no opioid use. The perioperative protocol can include a multimodal analgesic regimen. The patient should be observed for at least three hours after surgery. The patient should not be discharged without an alertness check and a neurological examination. Patients experienced significant improvements in PROs after ambulatory lumbar fusion; similarly, when compared to an inpatient group, ambulatory lumbar fusion patients experienced a comparable or superior improvement in PROs.
There are two critical issues surrounding ambulatory lumbar fusion: (1) Who is the ideal patient, and (2) What needs to be done to enable expedited discharge? We believe this review will provide a foundation to assist surgeons in making decisions regarding the performance of lumbar fusion on an ambulatory basis.
Level III.
研究设计/设置：系统评价。
主要目的是提出患者选择标准和围手术期最佳实践，作为门诊腰椎融合计划的起点。次要目的是回顾门诊腰椎融合术后患者报告的结果 (PROs)。
随着医疗成本的上升，人们越来越重视成本节约策略（即门诊/日间手术）。腰椎融合术仍然主要是住院手术。早期研究表明，融合术可以安全地在门诊环境中进行，但没有综述总结这些发现和最佳实践。
本研究按照系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行。检索了 PubMed/MEDLINE、Cochrane 图书馆和 Embase。收集了以下数据：(1) 研究设计；(2) 参与者人数；(3) 患者人群；(4) 手术类型；(5) 手术环境；(6) 纳入标准；(7) 方案；(8) 不良事件；(9) PROs；(10) 患者/手术因素、环境和结果之间的关联。
搜索结果产生了 20 篇出版物。确定了以下门诊腰椎融合的选择标准：年龄低于 70 岁，合并症较少，低/正常体重指数，不吸烟，不使用阿片类药物。围手术期方案可以包括多模式镇痛方案。患者应在手术后至少观察 3 小时。患者在未进行警觉性检查和神经检查的情况下不应出院。门诊腰椎融合术后患者的 PROs 显著改善；同样，与住院组相比，门诊腰椎融合术后患者的 PROs 改善程度相当或更高。
门诊腰椎融合术有两个关键问题：(1) 谁是理想的患者，(2) 为了实现加速出院需要做什么？我们相信，这篇综述将为外科医生在门诊进行腰椎融合术方面做出决策提供基础。
III 级。
