Resident Mayo Clinic Jacksonville, Florida, United States
Introduction: As a result of the increased focus on balancing high-quality care with appropriate healthcare resource utilization, recently there has been increased adoption of outpatient spine surgery. The objective of this study is to test the safety and readmission rates of same-day discharge to a virtual hybrid care hotel after spine surgery, to describe our protocol and lessons learned from our initial experience.
Methods: We analyzed all spine surgery patients discharged on the same day as surgery to a virtual hybrid care hotel at Mayo Clinic Florida from August 2020 to May 2021. We collected demographics, procedure and anesthesia types, adverse events, length of stay, 30-day readmissions.
Results: 75 patients were discharged to the care hotel on the same day of their spine surgery. Average age was 55.7±12.5 (SD), range 21-77 years; 38 (50.6%) were male; average BMI 30.4±5.5Kg/m2. 2 patients had ASA class 1; 49 ASA class 2; 23 ASA class 3; 6 were smokers, 34 had obesity, 35 hypertension, 14 diabetes mellitus, 13 OSAS. 41 patients underwent MIS lumbar laminectomy and/or microdiscectomy; 28 MIS-TLIFs; 3 cervical foraminotomies, 3 ACDFs. 53 patients had surgery under general anesthesia, 22 under spinal anesthesia. Average EBL 23.5±31.4ml. No intraoperative complications were recorded. Average hospital stay was 3.6±1.5 hours. 6 (8%) patients presented to the ER and required readmission within the 30 postoperative days, 3 had surgery under spinal and 3 under general anesthesia; 5 patients were readmitted due to uncontrolled back and/or leg pain, 1 patient was readmitted due to wound dehiscence and underwent an I&D.
Conclusion : Same-day discharge is feasible after spine surgery under general or spinal anesthesia. To obtain the best outcomes patient selection is crucial. We learned that patients with chronic pain syndrome and/or opioid dependence are not ideal candidates for same-day discharge as they may develop uncontrollable pain requiring rehospitalization.
