Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

Fallah, Aria; Massicotte, Eric M.; Fehlings, Michael G.; Lewis, Stephen J.; Rampersaud, Y. Raja; Ebrahim, Shanil; Bernstein, Mark

doi:10.1017/s0317167100009641

Cited by 31 publications

(18 citation statements)

References 15 publications

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“…Several studies have already been published claiming the feasibility, safety, and favorable clinical outcome after ACDF and posterior lumbar decompression in the outpatient setting. [8][9][10][11][12][13][14][15][16] However, there continues to be a great deal of skepticism regarding outpatient spine surgery, especially in the diagnosis and treatment of early surgical complications such as hematomas. This series of 1449 consecutive outpatient microsurgical spine decompressions, 376 cervical and 1073 lumbar, adds to the growing literature in favor of outpatient spine surgery, in properly selected patients.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

et al. 2015

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This series of 1449 consecutive outpatient microsurgical spine decompressions adds to the growing literature in favor of outpatient spinal surgery in properly selected patients. In our study, 99.8% of the patients were successfully discharged either to their homes or to a hotel on the day of surgery. The overall complication rate was 3.5%, surgical mortality was 0%, and only 1.5% had to be admitted to a hospital within 3 months after surgery.

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Section: Discussionmentioning

confidence: 99%

Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

et al. 2015

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“…15,26,34,71 Thus, the length of hospital stay was not examined due to its limited clinical significance. Although many of the potential benefits to MID, including deceased postoperative pain and faster mobilization, manifest during the initial postoperative period, few studies reported data on these parameters during this time period.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

Dasenbrock

Juraschek

Schultz

et al. 2012

SPI

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Object Advocates of minimally invasive discectomy (MID) have promoted this operation as an alternative to open discectomy (OD), arguing that there may be less injury to the paraspinal muscles, decreased postoperative pain, and a faster recovery time. However, a recently published large randomized controlled trial (RCT) comparing these approaches reported inferior relief of leg pain in patients undergoing MID. The authors conducted a meta-analysis to evaluate complications and improvement in leg pain in patients with radiculopathy enrolled in RCTs comparing OD to MID. Methods The authors performed a literature search using Medline and EMBASE of studies indexed between January 1990 and January 2011. Predetermined RCT eligibility included the usage of tubular retractors during MID, a minimum follow-up duration of 1 year, and quantification of pain with the visual analog scale (VAS). Trials that only evaluated patients with recurrent disc herniation were excluded. Data on operative parameters, complications, and VAS scores of leg pain were extracted by 2 investigators. A meta-analysis was performed assuming random effects to determine the difference in mean change for continuous outcomes and the risk ratio for binary outcomes. Results Six trials comprising 837 patients (of whom 388 were randomized to MID and 449 were randomized to OD) were included. The mean operative time was 49 minutes during MID and 44 minutes during OD; this difference was not statistically significant. Incidental durotomies occurred significantly more frequently during MID (5.67% compared with 2.90% for OD; RR 2.05, 95% CI 1.05–3.98). Intraoperative complications (incidental durotomies and nerve root injuries) were also significantly more common in patients undergoing MID (RR 2.01, 95% CI 1.07–3.77). The mean preoperative VAS score for leg pain was 6.9 in patients randomized to MID and 7.2 in those randomized to OD. With long-term follow-up (1–2 years postoperatively), the mean VAS score improved to 1.6 in both the MID and OD cohorts. There was no significant difference in relief of leg pain between the 2 approaches with either short-term follow-up (2–3 months postoperatively, 0.81 points on the VAS, 95% CI −4.71 to 6.32) or long-term follow-up (2.64 on the VAS, 95% CI −2.15 to 7.43). Reoperation for recurrent herniation was more common in patients randomized to the MID group (8.50% compared with 5.35% in patients randomized to the OD group), but this difference was not statistically significant (RR 1.56, 95% CI 0.92–2.66). Total complications did not differ significantly between the operations (RR 1.50, 95% CI 0.97–2.33). Conclusions The current evidence suggests that both OD and MID lead to a substantial and equivalent long-term improvement in leg pain. Adequate decompression, regardless of the operative approach used, may be the primary determinant of pain relief—the major complaint of many patients with radiculopathy. Incidental durotomies occurred significantly more frequently during MID, but total complications did not differ betwe...

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“…Lumbar microdiscectomy, initially performed in the hospi-neurológica número uno realizado en el país y la primera cirugía mayor de tal setting, has become the first major spine surgery to transition into the ambulatory setting. This push to move surgeries from an inpatient setting to ambulatory setting offers faster recovery time and better postoperative outcomes (12)(13)(14). Various studies (6,(12)(13)(14)(15) have stated that performing lumbar microdiscectomy in the outpatient setting can provide satisfactory outcomes but currently there is no study in the literature to the author's knowledge that analyses the incidence and location of surgery for lumbar microdiscectomy in a national sample.…”

Section: Introductionmentioning

confidence: 99%

“…This push to move surgeries from an inpatient setting to ambulatory setting offers faster recovery time and better postoperative outcomes (12)(13)(14). Various studies (6,(12)(13)(14)(15) have stated that performing lumbar microdiscectomy in the outpatient setting can provide satisfactory outcomes but currently there is no study in the literature to the author's knowledge that analyses the incidence and location of surgery for lumbar microdiscectomy in a national sample. The purpose of this study was to report on the incidence of lumbar microdiscectomy in the USA over a recent seven-year period (2007-2014), the associated procedural reimbursement costs associated with the inpatient and the outpatient setting and the demographic distribution of the surgeries.…”

Section: Introductionmentioning

confidence: 99%

Trends in Inpatient versus Outpatient Lumbar Microdiscectomy in the United States of America: An Epidemiologic and Economic Analysis

Pencle¹,

Brown²,

Rosas³

et al. 2017

West Indian Med J

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Objective: Lumbar discopathy is the most common cause for lower back-pain with the exception of non-specific lower back-pain. Lumbar microdiscectomy is the number one neurological surgery procedure performed in the country and is the first major spine surgery to transition to the ambulatory setting. Analysis on a national level is important to understand the transition in healthcare. The authors aim to report on the incidence of lumbar microdiscectomy and the associated procedural reimbursement costs over a seven-year period using a national database in the United States of America (USA). Methods: A query was performed for patients who underwent lumbar microdiscectomy using the Pearldiver Supercomputer (Warsaw, IN) from 2007 to 2014. Patients were identified by current procedural terminology (CPT) codes 63020, 63030 and 63035 and their demographics, location of surgery and reimbursement costs were later analysed. Results: The query returned a total of 38 636 lumbar microdiscectomies over the seven-year study period of 2007 to 2014. The total number of procedures performed as outpatients increased significantly from 906 in 2007 to 2647 in 2014 (p = 0.015); whereas those performed as inpatients had a smaller increase from 2437 in 2007 to 2788 in 2014 (p = 0.888). Of the total amount of surgeries, 20 884 (60.1%) were performed in the inpatient setting compared to 12 765 (39.9%) in an outpatient setting, (p < 0.001). The seven-year mean reimbursement cost for lumbar microdiscectomy done in the inpatient setting was $809.75 compared to $4181.88 in the outpatient setting, which was statistically significant (p = 0.027). Correlation analysis demonstrated that the increase in the incidence of outpatient lumbar microdiscectomy being performed had a high correlation (R = 0.914) to reimbursements, with a significance of p = 0.002. Conclusion: There has been a significant increase in lumbar microdiscectomy over the past seven years being performed as outpatient procedures. Mean reimbursement was shown to be a significant correlating factor for this increase.

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Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

Cited by 31 publications

References 15 publications

Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe

The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

Trends in Inpatient versus Outpatient Lumbar Microdiscectomy in the United States of America: An Epidemiologic and Economic Analysis

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