Analysis of surgeon experience and impact of comorbidities on early discharge after mini-open transforaminal lumbar interbody fusion

Background: Mini-open transforaminal lumbar interbody fusion (TLIF) has emerged as an alternative to open lumbar fusion. Currently, there is a limited amount of literature concerning the learning curve and perioperative variables of mini-open TLIF despite literature suggesting its overall advantage over open procedures. The objectives of this study were to evaluate the learning curve associated with mini-open TLIF and to identify factors affecting length of stay (LOS). Methods: Retrospective review of one surgeon's first 100 mini-open TLIF cases was performed to evaluate operative time, LOS, estimated blood loss (EBL), Oswestry Disability Index (ODI), visual analog pain scores (VAS), and fusion status. Operative time and LOS data were used to determine a proficiency point. Additional patient factors were collected and their impact on LOS was determined. Results: Operative time was found to be significantly less after 21 patients and LOS shorter after 22 patients. No significant differences were found when the first 22 patients were compared to the last 78 patients for ODI, VAS, and fusion status. Factors associated with decreased LOS include shorter operative time, lower EBL, later point on the learning curve of the surgeon, and patient factors including lower body mass index, being married or living with a significant other, and having a prior lumbar surgery. Conclusions: A significant learning curve is associated with mini-open TLIF. Similar follow-up outcomes suggest satisfactory outcomes even during the learning curve period.