Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review
Objective: To determine nationally how outpatient surgery affects transforaminal lumbar interbody fusion (TLIF) outcomes versus the inpatient setting. Methods: TLIF patients were identified from the National Surgical Quality Improvement database for the years 2015–2020 and stratified into inpatient...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | World Neurosurgery: X |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590139725000523 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1839623754907385856 |
|---|---|
| author | Simon G. Ammanuel Kaissa Sylla Cuong P. Luu Momin M. Mohis Bradley Schmidt |
| author_facet | Simon G. Ammanuel Kaissa Sylla Cuong P. Luu Momin M. Mohis Bradley Schmidt |
| author_sort | Simon G. Ammanuel |
| collection | DOAJ |
| description | Objective: To determine nationally how outpatient surgery affects transforaminal lumbar interbody fusion (TLIF) outcomes versus the inpatient setting. Methods: TLIF patients were identified from the National Surgical Quality Improvement database for the years 2015–2020 and stratified into inpatient and outpatient groups. Univariate and multivariate analyses, adjusting for differing patient characteristics, were performed to delineate outcome differences. A review of PubMed following PRISMA guidelines summarized prior level 3 evidence on how outpatient TLIF had affected outcomes. Results: Contrasting the characteristics of the 10,237 inpatient to 358 outpatient TLIF cases, the outpatient group fared younger (57.1 vs. 59.9 years old, p < 0.001) and lower in ASA >2 (42.2 % vs. 51.1 % p = 0.001). The outpatient group experienced shorter operations (183.86 vs. 214.29 min, p < 0.001), shorter stays (1.97 vs. 3.40 days, p < 0.001), and more home discharges (94.1 % vs. 87.1 %, p < 0.001). The outpatient group experienced fewer minor complications (4.7 % vs 10.7 %, p < 0.001), particularly perioperative blood transfusion (0.8 % vs 6.0 %, p < 0.001). Multivariate analysis showed outpatient group did not differ in major complications (OR 0.92, CI 0.45–1.88, p = 0.82) or readmissions (OR 1.06, CI 0.64–1.77, p = 0.82). A review of 7 smaller retrospective cohort studies revealed that complications rates (6 of 7 studies, p ≥ 0.05), the visual analog scale, and the Oswestry Disability Index (3 of 4 studies, p ≥ 0.05) did not differ between settings. Conclusions: TLIF can be performed safely in the outpatient setting with comparable outcomes to inpatient TLIF with prudent patient selection. It is also likely to have similar long-term functional outcomes, which therefore supports its expanded coverage under Medicare. |
| format | Article |
| id | doaj-art-ff1ca0b05df24a13a02c46573e83c9d2 |
| institution | Matheson Library |
| issn | 2590-1397 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Neurosurgery: X |
| spelling | doaj-art-ff1ca0b05df24a13a02c46573e83c9d22025-07-19T04:39:11ZengElsevierWorld Neurosurgery: X2590-13972025-07-0127100478Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic reviewSimon G. Ammanuel0Kaissa Sylla1Cuong P. Luu2Momin M. Mohis3Bradley Schmidt4Department of Neurosurgery, University of Wisconsin–Madison, Madison, WI, USA; Corresponding author. University of Wisconsin School of Medicine and Public Health, USA.School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USASchool of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USASchool of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USADepartment of Neurosurgery, University of Wisconsin–Madison, Madison, WI, USAObjective: To determine nationally how outpatient surgery affects transforaminal lumbar interbody fusion (TLIF) outcomes versus the inpatient setting. Methods: TLIF patients were identified from the National Surgical Quality Improvement database for the years 2015–2020 and stratified into inpatient and outpatient groups. Univariate and multivariate analyses, adjusting for differing patient characteristics, were performed to delineate outcome differences. A review of PubMed following PRISMA guidelines summarized prior level 3 evidence on how outpatient TLIF had affected outcomes. Results: Contrasting the characteristics of the 10,237 inpatient to 358 outpatient TLIF cases, the outpatient group fared younger (57.1 vs. 59.9 years old, p < 0.001) and lower in ASA >2 (42.2 % vs. 51.1 % p = 0.001). The outpatient group experienced shorter operations (183.86 vs. 214.29 min, p < 0.001), shorter stays (1.97 vs. 3.40 days, p < 0.001), and more home discharges (94.1 % vs. 87.1 %, p < 0.001). The outpatient group experienced fewer minor complications (4.7 % vs 10.7 %, p < 0.001), particularly perioperative blood transfusion (0.8 % vs 6.0 %, p < 0.001). Multivariate analysis showed outpatient group did not differ in major complications (OR 0.92, CI 0.45–1.88, p = 0.82) or readmissions (OR 1.06, CI 0.64–1.77, p = 0.82). A review of 7 smaller retrospective cohort studies revealed that complications rates (6 of 7 studies, p ≥ 0.05), the visual analog scale, and the Oswestry Disability Index (3 of 4 studies, p ≥ 0.05) did not differ between settings. Conclusions: TLIF can be performed safely in the outpatient setting with comparable outcomes to inpatient TLIF with prudent patient selection. It is also likely to have similar long-term functional outcomes, which therefore supports its expanded coverage under Medicare.http://www.sciencedirect.com/science/article/pii/S2590139725000523TLIFSpine surgery30-Day outcomesMajor complicationsFunctional outcomesoutpatient selection criteria |
| spellingShingle | Simon G. Ammanuel Kaissa Sylla Cuong P. Luu Momin M. Mohis Bradley Schmidt Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review World Neurosurgery: X TLIF Spine surgery 30-Day outcomes Major complications Functional outcomes outpatient selection criteria |
| title | Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review |
| title_full | Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review |
| title_fullStr | Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review |
| title_full_unstemmed | Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review |
| title_short | Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review |
| title_sort | outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting analysis of 10 595 nsqip patients and systematic review |
| topic | TLIF Spine surgery 30-Day outcomes Major complications Functional outcomes outpatient selection criteria |
| url | http://www.sciencedirect.com/science/article/pii/S2590139725000523 |
| work_keys_str_mv | AT simongammanuel outpatienttransforaminallumbarinterbodyfusiondemonstratedfavorablesafetyincomparisontotheinpatientsettinganalysisof10595nsqippatientsandsystematicreview AT kaissasylla outpatienttransforaminallumbarinterbodyfusiondemonstratedfavorablesafetyincomparisontotheinpatientsettinganalysisof10595nsqippatientsandsystematicreview AT cuongpluu outpatienttransforaminallumbarinterbodyfusiondemonstratedfavorablesafetyincomparisontotheinpatientsettinganalysisof10595nsqippatientsandsystematicreview AT mominmmohis outpatienttransforaminallumbarinterbodyfusiondemonstratedfavorablesafetyincomparisontotheinpatientsettinganalysisof10595nsqippatientsandsystematicreview AT bradleyschmidt outpatienttransforaminallumbarinterbodyfusiondemonstratedfavorablesafetyincomparisontotheinpatientsettinganalysisof10595nsqippatientsandsystematicreview |