Shorter length of stay associated with better outcomes after ALIF
Results showed patients who had a length of stay of less than 45 hours following anterior lumbar interbody fusion demonstrated greater minimum clinically important difference achievement for several patient-reported and functional outcomes.
Researchers from the department of orthopedic surgery at Rush University Medical Center retrospectively reviewed data on a cohort of 52 patients with a length of stay (LOS) of less than 45 hours after single-level ALIF and a cohort of 52 patients with a LOS of greater than or equal to 45 hours after ALIF. Follow-up was performed at 6-week, 12-week, 6-month, 1-year and 2-year postoperative timepoints, according to the study.
Patients who had a LOS of less than 45 hours following ALIF demonstrated greater MCID achievement for several outcomes.
Patient-reported outcomes measures (PROMs) included VAS back and leg pain score, Oswestry Disability Index (ODI), SF-12 physical composite score (SF-12 PCS) and patient-reported outcome measurement information system physical function score. Researchers also analyzed minimum clinically important difference (MCID) achievement rates, complication rates and relative risk factors for a longer LOS.
Researchers found a LOS of less than 45 hours was associated with greater MCID achievement rates for all PROMs except VAS back pain scores. In comparison, a LOS of greater than or equal to 45 hours was associated with worse ODI scores at 6 weeks, worse SF-12 PCS scores at 12 weeks, postoperative urinary retention, fever and increased complications, the researchers noted.
Preoperative risk factors, such as diabetes, increased VAS neck pain scores and increased American Society of Anesthesiologists classifications, were also associated with a LOS of greater than or equal to 45 hours and increased blood loss.
“Comprehensive preoperative education on risk factors, expected outcomes and complications associated with prolonged discharge status should be discussed prior to ALIF to encourage reduction of modifiable risk factors and better align expectations with realistic perioperative/postoperative outcomes,” the researchers wrote in the study.