• Pratyush Shahi, Avani S Vaishnav, Dimitra Melissaridou, Ahilan Sivaganesan, Jose M Sarmiento, Hikari Urakawa, Kasra Araghi, Daniel J Shinn, Junho Song, Sidhant S Dalal, Sravisht Iyer, Evan D Sheha, James E Dowdell, and Sheeraz A Qureshi.
• Department of Spine Surgery, Hospital for Special Surgery, New York, NY.
• Spine. 2022 Aug 15; 47 (16): 113711441137-1144.

Study DesignRetrospective review of prospectively collected data.ObjectiveTo analyze the postoperative factors that led delayed discharge in patients who would have been eligible for ambulatory lumbar fusion (ALF).Summary Of Background DataAssessing postoperative inefficiencies is vital to increase the feasibility of ALF.Materials And MethodsPatients who underwent single-level minimally invasive transforaminal lumbar interbody fusion and would have met the eligibility criteria for ALF were included. Length of stay (LOS); time in postanesthesia recovery unit (PACU); alertness and neurological examination, and pain scores at three and six hours; type of analgesia; time to physical therapy (PT) visit; reasons for PT nonclearance; 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.ResultsOf 71 patients, 4% were discharged on the same day and 69% on postoperative day 1. PT clearance was the last-met discharge criterion in 93%. Sixty-six percent did not get PT evaluation on the day of surgery. Seventy-six percent required intravenous opioids and <60% had adequate pain control. Twenty-six percent had orthostatic intolerance. 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 first void was 6.3 hours, time to first 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 three hours had a significant effect on LOS.ConclusionsUnavailability of PT, surgery after 1  pm , orthostatic intolerance, inadequate pain control, prolonged PACU stay, and long feeding and voiding times were identified as modifiable factors preventing same-day discharge.Level Of Evidence4.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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