Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T07:34:56.553Z Has data issue: false hasContentIssue false
  • English
  • Français

Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

Published online by Cambridge University Press:  02 December 2014

Aria Fallah ,
Eric M. Massicotte ,
Michael G. Fehlings ,
Stephen J. Lewis ,
Yoga Raja Rampersaud ,
Shanil Ebrahim  and
Mark Bernstein
Aria Fallah
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Eric M. Massicotte
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Michael G. Fehlings
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Stephen J. Lewis
Affiliation:
Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
Yoga Raja Rampersaud
Affiliation:
Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
Shanil Ebrahim
Affiliation:
Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
Mark Bernstein*
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
*
Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long term pain relief is not examined in this study.

Methods:

Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted.

Results:

In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS(6.7%), SS(7.3%)] (p>0.5) and admission rate [NS(4.1%), SS(5.8%)] (p=0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS(4.1%), SS(37.2%)] (p<0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS(5.4%), SS(1.2%)] (p=0.09) and conversion to inpatient [NS(4.3%), SS(4.6%)] (p>0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively.

Conclusion:

Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.

Objectif:

Spécialisation est généralement associée de façon indépendante à de meilleurs résultats dans la plupart des types de chirurgies. Il s'agit de la première étude comparant le taux de complications aiguës et l'hospitalisation pour évaluer le succès immédiat de la microdiscectomie lombaire en externe. Le soulagement de la douleur à long terme n'a pas été examiné dans cette étude.

Méthodes:

Nous avons révisé rétrospectivement deux bases de données prospectives (celle d'un neurochirurgien, spécialiste du traitement de tumeurs cérébrales, mais non pas de la colonne vertébrale (NS) et celle de 4 chirurgiens spécialistes de la colonne vertébrale (SS)). Toutes les données concernant les complications aiguës et les hospitalisations des patients inscrits pour une microdiscectomie lombaire en externe ont été extraites.

Résultats:

En tout, 269 patients appartenaient au groupe NS et 137 patients au groupe SS. Le groupe NS comptait en moyenne environ 24 cas par année alors que le groupe SS en comptait 50 par année. Les tests du chi-carré n'ont montré aucune différence quant au taux de complications aiguës (NS 6,7%; SS 7,3%; p > 0,5) et au taux d'hospitalisation (NS 4,1%; SS 5,8%; p = 0,4) et le groupe SS avait une proportion significativement plus élevée de patients qui subissaient une nouvelle microdiscectomie (NS 4,1%; SS 37,2%; p < 0,0001). Après exclusion des reprises chirurgicales, il n'existait pas de différence significative au point de vue statistique quant aux complications aiguës (NS 5,4%; SS 1,2%; p = 0,09) et au taux d'hospitalisation (NS 4,3%; SS 4,6%; p > 0,5). Le taux combiné de complications aiguës et d'hospitalisation était de 6,9% et de 4,7% respectivement.

Conclusion:

La microdiscectomie lombaire effectuée en externe peut, selon notre étude dont la portée est limitée, être effectuée sans danger et comporte des taux de complications immédiates similaires, que ce soit fait par un neurochirurgien non spécialisé en chirurgie de la colonne vertébrale ou par un chirurgien spécialisé en chirurgie de la colonne vertébrale, bien qu'il y ait une tendance favorisant ce dernier groupe dans les deux mesures d'évaluation utilisées dans notre étude.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 1 , January 2010 , pp. 49 - 53
Copyright
Copyright © The Canadian Journal of Neurological 2010

References

1. Chowdhury, MM, Dagash, H, Pierro, A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94:145–61.Google Scholar
2. Hersht, M, Massicotte, EM, Bernstein, M. Patient satisfaction with outpatient lumbar microdiscectomy: a qualitative study. Can J Surg. 2007;50:445–9.Google Scholar
3. Bookwalter, JW, Busch, MD, Nicely, D. Ambulatory surgery is safe and effective in radicular disc disease. Spine. 1994;117:1738–45.Google Scholar
4. Korres, DS, Loupassis, G, Stamos, K. Results of lumbar discectomy: a study using 15 different evaluation methods. Eur Spine J. 1992;1:20–4.Google Scholar
5. Law, JD, Lehman, RAW, Kirsch, WM. Reoperation after lumbar intervertebral disc surgery. J Neurosurg. 1978;48:259–63.Google Scholar
6. Osterman, H, Sund, R, Seitsalo, S, Keskimaki, I. Risk of multiple reoperations after lumbar discectomy: a population-based study. Spine. 2003;28:621–7.Google Scholar
7. Wiese, M, Kramer, J, Bernsmann, K, Willburger, RE. The related outcome and complication rate in primary microscopic disc surgery depending on the surgeon’s experience: comparative studies. Spine J. 2004;4:550–6.Google Scholar
8. An, HS, Simpson, JM, Stein, R. Outpatient laminotomy and discectomy. J Spinal Disord. 1999;12:192–6.Google Scholar
9. Asch, HL, Lewis, PJ, Moreland, DB, Egnatchik, JG, Yu, YJ, Clabeaux, DE et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? J Neurosurg. 2002;96:34–44.Google Scholar
10. Singhal, A, Bernstein, M. Outpatient lumbar microdiscectomy: a prospective study in 122 patients. Can J Neurol Sci. 2002;29:249–52.Google Scholar
11. Stolke, D, Sollman, WP, Seifert, V. Intra- and postoperative complications in lumbar disc surgery. Spine. 1989;14:56–9.Google Scholar
12. Bednar, DA. Analysis of factors affecting successful discharge in patients undergoing lumbar discectomy for sciatica performed on a day-surgical basis: a prospective study of sequential cohorts. J Spinal Disord. 1999;12:359–62.Google Scholar
13. Best, NB, Sasso, RC. Success and safety in outpatient microlumbar discectomy. J Spinal Disord Tech. 2006;19:334–7.Google Scholar
14. Shaikh, S, Chung, F, Imarengiaye, C, Yung, D, Bernstein, M. Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy. Can J Anesth. 2003;50:514–8.Google Scholar
15. Woodrow, SI, Bernstein, M, Wallace, MC. Safety of intracranial aneurysm surgery performed in a postgraduate training program: implications for training. J Neurosurg. 2005;102:616–21.Google Scholar
16. Reeves, BC. Principles of research: limitations of non-randomized studies. Surgery (Oxford). 2006;24:263–7.Google Scholar