Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Aug 2022
15 Aug 2022
Historique:
received:
19
01
2022
accepted:
14
04
2022
pubmed:
8
7
2022
medline:
10
8
2022
entrez:
7
7
2022
Statut:
ppublish
Résumé
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. 4.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective review of prospectively collected data.
OBJECTIVE
OBJECTIVE
To analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Assessing postoperative inefficiencies is vital to increase the feasibility of ALF.
MATERIALS AND METHODS
METHODS
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.
RESULTS
RESULTS
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.
CONCLUSIONS
CONCLUSIONS
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.
LEVEL OF EVIDENCE
METHODS
4.
Identifiants
pubmed: 35797654
doi: 10.1097/BRS.0000000000004380
pii: 00007632-202208150-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1137-1144Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Missios S, Bekelis K. Hospitalization cost after spine surgery in the United States of America. J Clin Neurosci. 2015;22:1632–7.
Debt.org. Fay B. Hospital and Surgery Costs. Available at: https://www.debt.org/medical/hospital-surgery-costs/ . Accessed January 5, 2022.
Regenbogen SE, Cain-Nielsen AH, Norton EC, Chen LM, Birkmeyer JD, Skinner JS. Costs and consequences of early hospital discharge after major inpatient surgery in older adults. JAMA Surg. 2017;152:e170123.
Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976). 2019;44:369–76.
Chin KR, Coombs AV, Seale JA. Feasibility and patient-reported outcomes after outpatient single-level instrumented posterior lumbar interbody fusion in a surgery center: preliminary results in 16 patients. Spine (Phila Pa 1976). 2015;40:E36–42.
Techy F, Benzel EC. Implementing an outpatient ambulatory discectomy protocol at a large academic center: a change for the better. World Neurosurg. 2015;83:341–2.
Fallah A, Massicotte EM, Fehlings MG, et al. Admission and acute complication rate for outpatient lumbar microdiscectomy. Can J Neurol Sci. 2010;37:49–53.
Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Minimally invasive lumbar decompression in an ambulatory surgery center. J Spine Surg. 2019;5(suppl 2):S166–73.
Hirsch BP, Khechen B, Patel DV, Cardinal KL, Guntin JA, Singh K. Safety and efficacy of revision minimally invasive lumbar decompression in the ambulatory setting. Spine (Phila Pa 1976). 2019;44:E494–9.
Holly LT, Moftakhar P, Khoo LT, et al. Minimally invasive 2-level posterior cervical foraminotomy: preliminary clinical results. J Spinal Disord Tech. 2007;20:20–4.
Vaishnav A, Hill P, McAnany S, et al. Comparison of multilevel anterior cervical discectomy and fusion performed in an inpatient versus outpatient setting. Glob Spine J. 2019;9:834–42.
Vaishnav A, Hill P, McAnany S, Gang CH, Qureshi S. Safety of 2-level anterior cervical discectomy and fusion (ACDF) performed in an ambulatory surgery setting with same-day discharge. Clinical Spine Surgery. 2019;32:E153–9.
Hill P, Vaishnav A, Kushwaha B, et al. Comparison of inpatient and outpatient preoperative factors and postoperative outcomes in 2-level cervical disc arthroplasty. Neurospine. 2018;15:376–82.
Arshi A, Park HY, Blumstein GW, et al. Outpatient posterior lumbar fusion: a population-based analysis of trends and complication rates. Spine (Phila Pa 1976). 2018;43:1559–65.
Purger DA, Pendharkar AV, Ho AL, et al. Outpatient vs inpatient anterior cervical discectomy and fusion: a population-level analysis of outcomes and cost. Neurosurgery. 2018;82:454–64; Erratum in: Neurosurgery . 2019;85:298.
Louie PK, Vaishnav AS, Gang CH, et al. Development and initial internal validation of a novel classification system for perioperative expectations following minimally invasive degenerative lumbar spine surgery. Clin Spine Surg. 2021;34:E537–44.
Vaishnav AS, Merrill RK, Sandhu H, et al. A review of techniques, time demand, radiation exposure, and outcomes of skin-anchored intraoperative 3d navigation in minimally invasive lumbar spinal surgery. Spine (Phila Pa 1976). 2020;45:E465–76.
Vaishnav AS, Saville P, McAnany S, et al. Retrospective review of immediate restoration of lordosis in single-level minimally invasive transforaminal lumbar interbody fusion: a comparison of static and expandable interbody cages. Oper Neurosurg (Hagerstown). 2020;18:518–23.
Alluri RK, Sivaganesan A, Vaishnav AS, Qureshi SA.Robotic guided minimally invasive spine surgery [Online First], IntechOpen ; 2021.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
Harris PA, Taylor R, Minor BL, et al. REDCap Consortium, The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
Deljou A, Hedrick SJ, Portner ER, et al. Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration. Br J Anaesth. 2018;120:798–806.
Waelkens P, Alsabbagh E, Sauter A, Joshi GP, Beloeil H. on behalf of the PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain therapy (ESRA). Pain management after complex spine surgery. Eur J Anaesthesiol. 2021;38:985–994.
Pinar H, Karaca O, Karakoc F. Effects of addition of preoperative intravenous ibuprofen to pregabalin on postoperative pain in posterior lumbar interbody fusion surgery. Pain Res Manag. 2017;2017:1030491.
Neifert SN, Martini ML, Gal JS, et al. Afternoon surgical start time is associated with higher cost and longer length of stay in posterior lumbar fusion. World Neurosurg. 2020;144:e34–9.
Mayo BC, Massel DH, Bohl DD, Long WW, Modi KD, Singh K. Effect of Surgery start time on day of discharge in anterior cervical discectomy and fusion patients. Spine (Phila Pa 1976). 2016;41:1939–44.
Bundgaard-Nielsen M, Jorgensen CC, Jorgensen TB, Ruhnau B, Secher NH, Kehlet H. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth. 2009;102:756–62.
Jans Ø, Kehlet H. Postoperative orthostatic intolerance: a common perioperative problem with few available solutions. Can J Anaesth. 2017;64:10–5.
Jans Ø, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. Br J Anaesth. 2012;108:436–443.
Danninger T, Dehipawala S, Dilallo M, Slacek T, Opperer M, Memtsoudis SG. Arterial tone a predictor of orthostatic intolerance in patients undergoing posterior lumbar spine fusion. Eur J Anaesthesiol. 2014;31:63.
Chen A, Ashburn MA. Cardiac effects of opioid therapy. Pain Med. 2015;16(suppl 1):S27–31.
Subedi M, Bajaj S, Kumar MS, Yc M. An overview of tramadol and its usage in pain management and future perspective. Biomed Pharmacother. 2019;111:443–51.
Hamilton TW, Strickland LH, Pandit HG. A meta-analysis on the use of gabapentinoids for the treatment of acute postoperative pain following total knee arthroplasty. J Bone Joint Surg Am. 2016;98:1340–50.
Fabritius ML, Wetterslev J, Mathiesen O, Dahl JB. Dose-related beneficial and harmful effects of gabapentin in postoperative pain management—post hoc analyses from a systematic review with meta-analyses and trial sequential analyses. J Pain Res. 2017;10:2547–63.
Cavalcante AN, Sprung J, Schroeder DR, Weingarten TN. Multimodal analgesic therapy with gabapentin and its association with postoperative respiratory depression. Anesth Analg. 2017;125:141–6.
Jirarattanaphochai K, Thienthong S, Sriraj W, et al. Effect of parecoxib on postoperative pain after lumbar spine surgery: a bicenter, randomized, double-blinded, placebo-controlled trial. Spine (Phila Pa 1976). 2008;33:132–9.
Lau LL, Hung CT, Chan CK, et al. Anaesthetic clinical indicators in public hospitals providing anaesthetic care in Hong Kong: prospective study. Hong Kong Med J. 2001;7:251–60.
Chan JJI, Thong SY, Tan MGE. Factors affecting postoperative pain and delay in discharge from the post-anaesthesia care unit: a descriptive correlational study. Proc Singapore Healthc. 2018;27:118–24.
Lalani SB, Ali F, Kanji Z. Prolonged-stay patients in the PACU: a review of the literature. J Perianesth Nurs. 2013;28:151–5.
Joshi GP, Twersky RS. Fast tracking in ambulatory surgery. Ambul Surg. 2000;8:185–90.
Tammela T, Kontturi M, Lukkarinen O. Postoperative urinary retention. I. Incidence and predisposing factors. Scand J Urol Nephrol. 1986;20:197–201.
Jellish WS, Thalji Z, Stevenson K, Shea J. A prospective randomized study comparing short-and intermediate-term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery. Anesth Analg. 1996;83:559–64.
McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine. 2005;2:17–22.
Lee S, Kim CH, Chung CK, et al. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis. Spine J. 2017;17:469–77.
Kim S-J, Lee S-H, Eun SS, Chachan S. Can early first trial of void after elective spine surgery reduce the incidence of post-operative urinary retention?—Results from a cross-sectional study of 195 patients. J Spine Res Surg. 2020;2:037–43.
Soffin EM, Vaishnav AS, Wetmore DS, et al. Design and implementation of an enhanced recovery after surgery (ERAS) program for minimally invasive lumbar decompression spine surgery: initial experience. Spine (Phila Pa 1976). 2019;44:E561–70.
Zou Y, Zhang X, Li Y, Liu C. Preliminary study on the feasibility of early feeding after general anesthesia and lumbar spine surgery in middle-aged and elderly patients. Am J Nurs Sci. 2019;8:346–50.
York PJ, Gang CH, Qureshi SA. Patient education in an ambulatory surgical center setting. J Spine Surg. 2019;5(suppl 2):S206–11.
Lindbäck Y, Tropp H, Enthoven P, Abbott A, Öberg B. PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial. Spine J. 2018;18:1347–55.
Delgado-López PD, Rodríguez-Salazar A, Castilla-Díez JM. “Prehabilitation” in degenerative spine surgery: a literature review [English, Spanish]. Neurocirugia (Astur). 2019;30:124–32.
Abbott AD, Tyni-Lenne R, Hedlund R. The influence of psychological factors on preoperative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96:213–221.