Minimally Invasive Surgery - Transforaminal Lumbar Interbody Fusion: Medical center in Florida
Study Methods
- 38 adult patients treated with enhanced recovery protocol after MIS TLIF were analyzed retrospectively and compared with 15 adult patients who underwent MIS TLIF before the implementation of ERP (N=53)
- All patients underwent standard MIS TLIF, but the control group did not receive all ERP components, including EXPAREL
Safety Outcomes
- The overall rate of complications was lower in the ERP group (12% versus 21%)*
Clinical and Economic Outcomes
Patients who received ERP with EXPAREL to manage pain after surgery had
2.7days
shorter length of stay
- 1.2 vs 3.9 days (P=0.009)
$3444
reduction in total cost for acute-care hospitalization†
- $19,212 vs $22,656 (P<0.001)
100%
rate of
discharge home- 100% vs 86%
STANDARD MIS TLIF (n=15)
- Standard surgical protocol utilizing 3 out of 6 ERP components
- Expandable cage
- Bone morphogenetic protein
- Small-caliber percutaneous screws
- General anesthesia
ERP WITH EXPAREL (n=38)
- ERP surgical protocol with all 6 components
- Local infiltration into the surgical site with EXPAREL expanded with saline and bupivacaine hydrochloride
- Anesthesia without intubation
- Working channel endoscope
- Expandable cage
- Bone morphogenetic protein
- Small-caliber percutaneous screws
*The statistical significance of decreased complications was not evaluated.
†Areas of greatest savings included a reduction in intensive care unit costs, shorter overall LOS, and decreased costs from a reduced operating room duration.
MIS, minimally invasive surgery; TLIF, transforaminal lumbar interbody fusion; ERP, enhanced recovery protocol; LOS, length of stay.