Study design: Retrospective analysis of a prospectively database.
Objectives: To identify factors associated with prolonged length of stay (LOS) in posterior /transforaminal lumbar interbody fusion (PLIF/TLIF).
Methods: The subjects were patients who underwent PLIF/TLIF at 10 facilities from 2012 to 2014. A total of 1168 such patients with a mean age of 65.9 ± 12.5 years (range 18-87 years) were identified in the database. Operations were PLIF (n = 675), TLIF (n = 443), minimally invasive surgery (MIS)-PLIF (n = 22), and MIS-TLIF (n = 32). Age, gender, body mass index, ambulatory status, comorbidities, perioperative American Society of Anesthesiologists (ASA) grade, operative factors, and complications were examined. LOS was defined as the number of calendar days from the operation to hospital discharge. LOS was categorized as normal (<75th percentile) or prolonged (≥75th percentile).
Results: The average LOS was 20.8 ± 9.8 days (range 7-77 days). There was a significant correlation between LOS and age (P < .05). Reoperation during hospitalization was performed in 20 cases for surgical site infection (n = 12), epidural hematoma (n = 5), and screw misplacement (n = 3). In multivariate analysis, prolonged LOS was associated with preoperative variables of age ≥70 years (odds ratio [OR] 1.87, 95% CI 1.38-2.54), and ASA class ≥III (OR 1.52, 95% CI 1.04-2.25); surgical variables of open procedures (OR 5.84, 95% CI 1.74-19.63), fused levels ≥3 (OR 5.17, 95% CI 3.17-8.43), operative time ≥300 minutes (OR 1.88, 95% CI 1.15-3.07), and estimated blood loss ≥500 mL (OR 1.71, 95% 1.07-2.75).
Conclusions: The factors identified in this study should help with obtaining informed consent, surgical planning and complication prevention to reduce health care costs associated with prolonged LOS.
Keywords: length of stay; multicenter; posterior lumbar interbody fusion (PLIF); postoperative complications; transforaminal lumbar interbody fusion (TLIF).
Conflict of interest statement
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Reoperation Within 2 Years After Lumbar Interbody Fusion: A Multicenter StudyK Kobayashi et al. Eur Spine J 27 (8), 1972-1980. PMID 29423887.Surgical invasiveness, as reflected by number of fused levels, operation time, EBL and dural tear, was associated with reoperation. Fusion of two or more levels is a stro …
Perioperative Outcomes and Adverse Events of Minimally Invasive Versus Open Posterior Lumbar Fusion: Meta-Analysis and Systematic ReviewCL Goldstein et al. J Neurosurg Spine 24 (3), 416-27. PMID 26565767. - ReviewThe result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology sug …
Approach-based Comparative and Predictor Analysis of 30-day Readmission, Reoperation, and Morbidity in Patients Undergoing Lumbar Interbody Fusion Using the ACS-NSQIP DatasetAD Katz et al. Spine (Phila Pa 1976) 44 (6), 432-441. PMID 30138253.PLIF/TLIF was associated with a 15.5% increased odds of morbidity; readmission and reoperation were similar between approaches. Older age, higher ASA-class, and specific …
Index Episode-Of-Care Propensity-Matched Comparison of Transforaminal Lumbar Interbody Fusion (TLIF) Techniques: Open Traditional TLIF Versus Midline Lumbar Interbody Fusion (MIDLIF) Versus Robot-Assisted MIDLIFMLP Ver et al. J Neurosurg Spine 1-7. PMID 31978884.Despite concerns for additional cost and time while introducing navigation or robotic technology, a propensity-matched comparison of the authors' first 52 RA-MIDLIF surge …
Transforaminal Lumbar Interbody Fusion (TLIF) Versus Posterior Lumbar Interbody Fusion (PLIF) in Lumbar Spondylolisthesis: A Systematic Review and Meta-AnalysisSL de Kunder et al. Spine J 17 (11), 1712-1721. PMID 28647584. - ReviewTLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score …
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