Methods: Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. Results: A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups. Conclusions Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.

The Space-D Access System is a new, minimally invasive surgery (MIS) retractor system that allows spine surgeons to perform transforaminal lumbar interbody fusion (TLIF) with intraoperative navigation. Unlike other retractors, this system allows distraction/compression and lateral retraction. This is the first description of the technical aspects of the Space-D Access System for MIS TLIF since its public debut in May 2021. This study introduces the components and applicability of the Space-D Access System and provides step-by-step instructions with visuals to perform a MIS TLIF using this novel device. The Space-D Access System, StealthStation, CD Horizon Solera Voyager, and an anatomic lumbar spine model were used to demonstrate the steps to successfully perform MIS TLIF. The components and applicability of the Space-D Access System are discussed. Detailed written instructions and visuals are provided in a stepwise fashion to complete MIS TLIF effectively and efficiently. The Space-D Access System is the only multifunctional device that allows tissue retraction and pedicle-to-pedicle distraction/compression while performing MIS TLIF. To our knowledge, this is the first paper to describe the device and its use for MIS TLIF with written instructions and visuals using an anatomic model.