Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score–matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43–0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09–0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p &lt; 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.</jats:p></jats:sec>

Risk factors for surgical site infection after lumbar laminectomy and/or discectomy for degenerative diseases in adults: A prospective multicenter surveillance study with registry of 4027 cases

“…An operating time >2 h was an independent risk factor ( P = 0.0095) for postoperative SSI after adjusting for all other variables. This result is consistent with those in previous literature that reported a prolonged surgical procedure as a significant risk factor for SSI [ 11 , 13 , 21 , 22 ]. Based on this finding, efforts to shorten the operative time could be useful in reducing SSI incidence.…”

“…Thus, a variety of risk factors for SSI after spinal surgery have been previously identified to prevent this significant complication. These risk factors include advanced age [ 3 ], male sex [ 4 ], obesity [ 5 , 6 ], previous spinal surgery [ 5 ], malnutrition [ 3 ], diabetes [ 5 – 7 ], smoking [ 5 ], spinal trauma [ 8 , 9 ], corticosteroid use [ 5 , 10 ], spinal instrumentation [ 11 ], posterior surgical approach [ 2 ], tumor resection [ 2 ], surgery involving sacrum [ 11 ], dural tear [ 12 ], conventional open spinal surgery instead of endoscopic tubular surgery [ 13 , 14 ], increased estimated blood loss [ 7 ], and prolonged operating time [ 11 , 15 ]. However, some of these studies were performed retrospectively at individual institutions and/or were limited by their relatively small sample size.…”

Robotic paravertebral schwannoma resection at extreme locations of the thoracic cavity

“…2,9,17,27 The clinical, institutional, and economic benefits of minimally invasive surgery have been extensively described in the neurosurgical literature. 13,14,21,24 The 2 cases featured in this report demonstrate that robot-assisted thoracoscopic resection is an effective therapy for certain paravertebral schwannomas in both the high superior and low inferior posterior mediastinum with excellent perioperative outcomes.…”

Determination of surgical exposure obtained with integrated endoscopic thoracolumbar hemilaminectomy in large‐breed cadaveric dogs

“…Many studies have provided evidence that a minimally invasive approach is equal or preferred to the standard open access for spinal surgery in human patients. Decreased blood loss, faster surgery time, decreased surgical site infections, decreased risk of surgical and medical complications, decreased postoperative pain, shorter length of time in intensive care, shorter hospital stays, shorter return to ambulation time, and decreased reoperation rates have all been shown to be benefits of minimally invasive spinal surgery compared with an open approach in human literature …”