Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation

Abstract

Aims The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. Patients and Methods This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Results Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. Conclusion The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470–477.

Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in-vitro experiment

“…Bleeding is one of the most common surgical complications of herniated lumbar disc surgeries (2). The blood loss under the endoscope during PELD is generally less than 10 ml, but there also can be massive bleeding.…”

“…The treatment for LDH include conservative therapy and surgery and the standard open discectomy has largely been replaced by microdiscectomy (1). According to a Norway longitudinal observation study of 34639 surgical cases of lumbar disc herniation, microdiscectomy was specified in 23929 patients (69%) (2). Percutaneous endoscopic lumbar discectomy (PELD) is one of the microdiscectomy methods which has made significant progress and is well accepted by surgeons in recent years with the development of endoscopic technique and surgical instruments (3,4).…”

International Society for the Advancement of Spine Surgery Policy 2019—Surgical Treatment of Lumbar Disc Herniation with Radiculopathy

“…The most common complications include dural tears (1%-4% of cases), 11,13,14,21,23 blood transfusions (2%-3% of cases), 14,21,23 and neural injuries (0.4% of cases). 21 None of the RCTs or prospective cohort studies reported cases of perioperative mortality, [11][12][13][14]17,[21][22][23][24][25] indicating that the risk of discectomy-related death is negligible. A recent (2019) analysis of 34 639 LDH operations performed over 15 years found that complications occurred in only 2.7% (95% confidence interval: 2.6%-2.9%) of cases, with no perioperative deaths.…”

“…15 Based on a health technology assessment, which included a systematic literature review, public feedback, and voting from a clinical committee, the Washington State Health Care Authority requires at least 6 weeks of nonsurgical care unless progressive motor weakness is present. 16,17 Thus, the decision to continue nonsurgical care or undergo surgery considers the patient history, physical examination, radiological findings, and severity of symptoms.…”

Full-endoscopic lumbar decompression versus open posterior interbody fusion for surgical treatment of stable lumbar disc herniation in patients over 65 years: A retrospective cohort study with 2-year follow-up

“…Lumbar disc herniation (LDH) accounts for a large proportion of low-back pain as it affects over 90% of individuals in their lifetime [1]. With an average onset age of 45 years, LDH usually occurs in people between 20 and 50 years of age and is relatively rare in the elderly [2]. LDH is often combined with ligamentum avum hypertrophy and lateral recess stenosis in older population, which lead to lumbar spinal stenosis (LSS) [3].…”