Resident Physician University of Nebraska Medical Center Omaha, NE, US
Disclosure(s):
Luke Weisbrod, MD: No financial relationships to disclose
Introduction: Due to rapidly rising healthcare 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 with pooled analysis to determine its safety and feasibility.
Methods: EMBASE (Elsevier), MEDLINE (EBSCO), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on April 8, 2024, for articles mentioning the 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; (4) a population ≥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 odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI) for each outcome.
Results: Pooled analysis included results from 4 studies. A total of 2,070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed outpatient ALIF compared to inpatient resulted in a statistically significant decrease in post-operative adverse events (OR -0.89, 95% CI [-1.69, -0.09], I2 = 54.88%, p = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], I2 = 0%, p = 0.816), and nearly statistically significant decreases in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], I2 = 0%, p = 0.05).
Conclusion : These meta-analyses suggest outpatient ALIF is associated with a statistically significant decrease in post-operative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.