After lumbar fusion, who are those patients whose discharge is most likely to be delayed and why? New work from Hospital for Special Surgery in New York has some thoughts about that. The study, “Factors Causing Delay in Discharge in Patients Eligible for Ambulatory Lumbar Fusion Surgery,” appears in the August 15, 2022, edition of Spine.
Sheeraz Qureshi, M.D., M.B.A., co-author and associate professor of orthopedic surgery at Hospital for Special Surgery and Weill Cornell Medical College in New York, gave OTW background on the study. “There continues to be an increasing amount of spine surgery that is being performed in hospital outpatient departments as well as ambulatory surgery centers. We believe our study is the first to look at what factors might cause patients who were planning to go home the same day after lumbar fusion surgery to have to spend the night in a hospital.”
The researchers homed in on 71 individuals who had one-level minimally invasive transforaminal lumbar interbody fusion for degenerative conditions who would have been eligible for ambulatory lumbar fusion.
In order to be discharged as planned, the study hospital required that each patient meet three criteria:
- physical therapy (PT) clearance (93% of patients),
- voiding (6%), and
- time to per-oral intake (1%).
A total of 66% of patients did not receive a PT evaluation on the day of surgery. Intravenous (IV) opioids for pain control (average of two doses) were required for 76% of patients. Fewer than 60% of patients had adequate pain control at three hours and six hours after the surgery.
Modifiable Factors
According to the research team, the median length of stay (LOS) was 26.9 hours, time in post-anesthesia care unit was 4.2 hours, time to per-oral intake—6.5 hours; time to first void—6.3 hours; time to first physical therapy visit—17.7 hours; time to physical therapy clearance—21.8 hours; and time to discharge readiness—21.9 hours.
The researchers determined that postoperative variables (time to physical therapy clearance, time to per-oral intake, time to voiding, time in the post-anesthesia care unit, and pain score at three hours) had a significant effect on LOS.
However, importantly, the research team found no effect of preoperative and operative variables on postoperative parameters influencing discharge.
“This is a particularly important topic in my opinion,” stated Dr. Qureshi to OTW, “because I believe we will see lumbar fusion surgery being performed with increasing frequency in ambulatory surgery centers that may not have the capacity to keep a patient overnight. The good news is that our study found several modifiable factors that could allow for increasing consistency in patient discharge disposition.”
