Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model

Abstract

Objective: The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.Methods: Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.Results: Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88).Conclusion: After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.

Trends in degenerative lumbar spinal surgery during the early COVID-19 pandemic in Republic of Korea: A national study utilizing the national health insurance database

“…Even those who experienced spontaneous improvement might have benefitted from surgery (e.g., less pain, potentially better neurologic recovery, etc.). Consequently, it is possible that certain patients continued to suffer from pain and disability and were unable to return to their normal lives [ 14 , 34 – 36 ]. With applying surgical criteria strictly to decide the necessity of elective lumbar surgeries, essential elective surgeries could be performed.…”

“…Overall, the distribution of surgical procedures did not substantially change. The distribution of surgical procedures for HIVD, however, saw an increase in discectomy and endoscopic discectomy, and a decrease in fusion surgery, which may suggest a pandemic-driven preference for less invasive procedures over more complex surgeries, likely due to concerns regarding extended hospital stays and postoperative care [ 14 , 36 – 39 ]. Conversely, for LSS and spondylolisthesis, the proportion of fusion surgeries increased, which is inconsistent with the presumed preference toward less invasive surgery.…”

Frailty concept in Africa neurosurgical practice: a prospective review

“…Frailty is found to be an important risk assessor in determining and improving the outcome of patients going for neurological surgeries such as brain tumor resection, deep brain stimulations, decompressive surgeries, and spinal surgeries in the Western world [16][17][18][19][20]. This concept, if adapted into neurosurgical practice in Africa, will have positive effects on various neurosurgical procedures through the identification of high-risk patients whose physiological states are not fit for the surgery, thereby reducing the postoperative mortalities and morbidities.…”

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“…Overall, the distribution of surgical procedures did not substantially change. The distribution of surgical procedures for HIVD, however, saw an increase in discectomy and endoscopic discectomy, and a decrease in fusion surgery, which may suggest a pandemic-driven preference for less invasive procedures over more complex surgeries, likely due to concerns regarding extended hospital stays and postoperative care [14,[36][37][38][39]. Conversely, for LSS and spondylolisthesis, the proportion of fusion surgeries increased, which is inconsistent with the presumed preference toward less invasive surgery.…”

“…Even those who experienced spontaneous improvement might have benefitted from surgery (e.g., less pain, potentially better neurologic recovery, etc.). Consequently, it is possible that certain patients continued to suffer from pain and disability and were unable to return to their normal lives [14,[34][35][36]. With applying surgical criteria strictly to decide the necessity of elective lumbar surgeries, essential elective surgeries could be performed.…”