Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses
Why this work is in the frame
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Bibliographic record
Abstract
<h3>Background</h3> Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility. <h3>Methods</h3> Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome. <h3>Results</h3> Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR −0.89, 95% CI [−1.69, –0.09], <i>I</i><sup>2</sup> = 54.88%, <i>P</i> = 0.03), comparable readmission rates (OR 0.02, 95% CI [−0.16, 0.20], <i>I</i><sup>2</sup> = 0%, <i>P</i> = 0.816), and nearly statistically significant decrease in reoperation rates (OR −0.41, 95% CI [−0.83, –0.00], <i>I</i><sup>2</sup> = 0%, <i>P</i> = 0.05). <h3>Discussion</h3> These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data. <h3>Clinical Relevance</h3> This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery. <h3>Level of Evidence</h3> 3.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it