Optimizing lie-to-stand time to avoid orthostatic intolerance during early mobilization after enhanced recovery after surgery program for minimally invasive spine surgery: oblique lateral interbody fusion versus minimally invasive transforaminal lumbar interbody fusion: a prospective cohort study in Thailand.

Abstract

Prospective study. To evaluate the hemodynamic response to early mobilization following oblique lateral interbody fusion (OLIF) compared to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with an enhanced recovery after surgery (ERAS) program. The ERAS program mitigates surgical stress and facilitates early recovery. Orthostatic intolerance (OI) may impede early mobilization after spine surgery. Data on OI after OLIF and MIS-TLIF with an ERAS are limited. This study compares OI incidence and outcomes of these two procedures. The hemodynamic response to postural changes (supine to sitting and standing) was evaluated preoperatively and at 6, 12, 24, and 48 hours postoperatively in 30 patients who underwent single-level OLIF versus MIS-TLIF within an ERAS protocol. The protocols were evaluated sequentially, beginning with a change from supine to sitting, followed immediately by standing, with the patient remaining in the standing position for 3 minutes for evaluation. This study compared OLIF and MIS-TLIF in 60 patients and found no significant differences in baseline characteristics. The OLIF group demonstrated greater hemodynamic stability within 6 hours after surgery, exhibiting smaller decreases in systolic blood pressure and mean arterial pressure, along with reduced fluid responsiveness compared to the MIS-TLIF group. Both groups of patients exhibited comparable heart rates and cardiac output stabilization over time. Clinically, OLIF resulted in greater postoperative back pain relief, lower blood loss (45±7.31 mL vs. 99.33±14.13 mL), and higher postoperative hemoglobin levels compared to MIS-TILF. Operative time, hospital stay, and complication rates were comparable between the OLIF and MIS-TLIF groups. OLIF was associated with improved hemodynamic parameters within 6 hours postoperatively, less blood loss, and improved pain relief compared to MIS-TLIF, while both procedures demonstrated similar operative times, hospital stays, and no complications.