Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-11-19 DOI:10.14444/8661

Luke J Weisbrod, Brandon L Staple, Danielle M Westmark, Andrew P Gard, Daniel L Surdell

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Abstract

Background: Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility.

Methods: Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome.

Results: Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR -0.89, 95% CI [-1.69, -0.09], I ² = 54.88%, P = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], I ² = 0%, P = 0.816), and nearly statistically significant decrease in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], I ² = 0%, P = 0.05).

Discussion: These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.

Clinical relevance: This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery.

Level of evidence: 3:

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门诊前路腰椎椎间融合手术的安全性：系统性回顾与 Meta 分析。

背景：由于医疗费用的快速上涨，人们正在探索利用门诊手术来减轻住院患者的负担。本研究对有关门诊前路腰椎椎体间融合术（ALIF）的文献进行了系统回顾，并进行了汇总分析，以确定其安全性和可行性：于 2024 年 4 月 8 日检索了 Embase（Elsevier）、MEDLINE（美国国家医学图书馆）、CINAHL（EBSCO）和 Cochrane 图书馆（Wiley）中提及以下检索概念的文章：(1) 非卧床；(2) 门诊；(3) ALIF 手术。纳入的研究必须：(1) 接受门诊 ALIF 手术的患者；(2) 有住院对照组；(3) 每个队列的样本量≥5；(4) 年龄≥18 岁的人群。从符合纳入标准的研究中提取结果数据，并对缺乏前瞻性随机设计的纳入研究进行纽卡斯尔-渥太华评分。采用固定效应和随机效应模型确定每项结果的ORs和平均差，以及95% CIs：汇总分析包括 4 项研究的结果。结果显示，与住院患者相比，门诊患者的术后不良事件显著减少（OR -0.89，95% CI [-1.69，-0.09]，I 2 = 54.88%，P = 0.03），再入院率相当（OR 0.02，95% CI [-0.16，0.20]，I 2 = 0%，P = 0.816），再手术率几乎有统计学意义的显著下降（OR -0.41，95% CI [-0.83，-0.00]，I 2 = 0%，P = 0.05）：讨论：这些荟萃分析表明，门诊 ALIF 与术后不良事件的统计学意义上的显著减少有关，但在再入院率或再手术率方面没有显著差异。这些结果表明，对于经过严格筛选的患者，门诊 ALIF 是安全可行的。本研究受限于对回顾性数据的汇总分析：本系统综述有助于评估门诊ALIF脊柱手术的安全性：3:

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.