Inpatient vs. Outpatient Lumbar Fusions: 5 Points of Comparison

Laura Dyrda -

Richard N. Wohns, MD, JD, MBA, founder and president of South Sound Neurosurgery in Puyallup, Wash., recently conducted a study titled "A Comparison of the Safety of Lumbar Fusions Performed as Outpatient (<25-Hour Discharge) or Inpatient (>24-Hour Discharge) Procedures." He presented the paper at the North American Spine Society 2012 Annual Meeting in October.
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Dr. Wohns collected the data as part of a prospective registry for a single institution and compared preoperative safety between the two groups. The study included 187 patients who underwent transforaminal lumbar interbody fusions from 2003 to 2011. Here were the patient demographics:

•    Average age was 54.5
•    52 percent were female, 48 percent were male
•    Average BMI was 29.4
•    37 percent were employed
•    13 percent received workers compensation
•    14 percent were smokers
•    9 percent had diabetes
•    8 percent had heart disease
•    48 percent experienced a prior surgery

Patients presented with a variety of symptoms, including back pain, leg pain, bowel and bladder dysfunction and weakness. Surgery was performed most commonly on L3-L4 and L4-L5. Fifty-nine percent of the patients received autograft and 36 percent received BMP.

Dr. Wohns found 46 percent of the patients were discharged within 24 hours or less postoperatively and 55 percent were discharged after 24 hours postoperatively. The characteristics that made patients more likely to be treated outpatient were:

•    Age — outpatients were slightly younger
•    Sex — men were more likely to receive outpatient treatment than women
•    Number of levels — one and two level cases were more likely to be treated outpatient

He found there were differences in several surgical factors:

1. Operative times — the average operative time for outpatient procedures was 90 minutes while the average operating time for inpatient procedures was 120 minutes.

2. Blood loss — an average of 140mL blood loss was experienced with outpatient procedures, compared to 353 mL of blood loss for inpatient procedures.

3. Exposure levels — minimally invasive exposures were more common in outpatients (46 percent) versus inpatients (19 percent)

4. Pedicle screw fixation
— pedicle screw fixation occurred in 67 percent of the inpatient procedures compared to 53 percent in the outpatient procedures.

5. Complication rate
— there were three patients who experienced complications in the outpatient group, compared to seven patients in the inpatient group, through three months postoperative examination. Additionally, four in-hospital complications occurred in the inpatient group, compared with none for the outpatient group.

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