Study design:

Retrospective review of prospectively collected data.

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:

Assessing postoperative inefficiencies is vital to increase the feasibility of ALF.

Methods:

Patients who underwent single-level MI-TLIF and would have met the eligibility criteria for ALF were included. Length of stay [LOS]; time in post-anesthesia recovery unit [PACU]; alertness and neurological exam, and pain scores at 3 and 6 hours; type of analgesia; time to physical therapy [PT] visit; reasons for PT non-clearance; 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:

Out of 71 patients, 4% were discharged on the same day and 69% on postoperative day one. PT clearance was the last-met discharge criterion in 93%. 66% did not get PT evaluation on the day of surgery. 76% required intravenous (IV) opioids and <60% had adequate pain control. 27% had orthostatic intolerance (OI). 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 1st void was 6.3 hours, time to 1st 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 3 hours had a significant effect on LOS.

Conclusions:

Unavailability of PT, surgery after 1 PM, OI, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge.

Level of evidence:

4.