Can the Full-Percutaneous Endoscopic Lumbar Discectomy in Day Surgery Mode Achieve Better Outcomes Following Enhanced Recovery after Surgery Protocol? A Retrospective Comparative Study

Abstract

BackgroundFull-percutaneous endoscopic lumbar discectomy (F-PELD) is a popular operation for the treatment of lumbar disc herniation (LDH). Some studies have reported that F-PELD in day surgery mode produced favorable outcomes for LDH. At the same time, minimally invasive spinal surgery following enhanced recovery after surgery (ERAS) presents a rising trend in recent years, but few studies reported whether F-PELD will produce better outcomes in the day surgery (DS) mode combined with ERAS.ObjectiveTo analyze whether F-PELD in day surgery mode following ERAS can produce better clinical outcomes than in traditional surgery mode.MethodsThe patients who underwent F-PELD between January 2019 and October 2020 were retrospectively analyzed, and the patients who met the inclusive criteria were followed up. The patients were divided into day surgery (DS) group (n = 152) that combined with ERAS and traditional surgery (TS) group (n = 123) without ERAS. The length of hospital stays (LOS), visual analogue scale (VAS), and Oswestry Disability Index (ODI) of two groups were compared before surgery, immediately after surgery, one month after surgery, and one year after surgery.ResultsA total of 298 patients who underwent F-PELD were reviewed. 290 patients were included in the study and followed up, and 275 patients who had completed the follow-up were available for analysis. There were no statistically significant differences between the two groups in terms of age, gender, preoperative VAS, and ODI. There were significant statistical differences in the VAS and ODI immediately after surgery (VAS for back pain: DS group 1.4 ± 1.1, TS group 2.0 ± 1.2, p < 0.001; VAS for leg pain: DS group 0.8 ± 0.8, TS group 1.1 ± 1.1, p = 0.010; ODI: DS group 5.8 ± 4.3, TS group 7.6 ± 7.4, p = 0.010) and one month after surgery (VAS for back pain: DS group 0.8 ± 0.9, TS group 1.1 ± 1.0, p = 0.035; ODI: DS group 3.2 ± 3.5, TS group 4.5 ± 6.5, p = 0.036). At one year after surgery, the VAS (back pain: DS group 0.3 ± 0.6, TS group 0.3 ± 0.7, p = 0.798; leg pain: DS group 0.2 ± 0.4, TS group 0.1 ± 0.4, p = 0.485) and ODI (DS group 0.8 ± 1.2, TS group 0.7 ± 1.7, p = 0.729) were further improved, but no statistically significant difference was observed between two groups. LOS of DS group (1.38 ± 0.49 days) was significantly shorter than the TS group (5.83 ± 2.24 days, p < 0.001), and some postoperative complications occurred in the TS group, including throat discomfort (n = 5, 4.1%), discomfort after catheterization (n = 7, 5.7%), abdominal distention (n = 3, 2.4%), and nausea (n = 5, 4.1%). None of the above complications resulted in serious consequences.ConclusionThe F-PELD in day surgery mode following ERAS produced a better short-term clinical effect and reduced the LOS, which is worthy of promotion.

Does Immediate Postoperative Early Ambulation Affect Clinical Results of Full‐Endoscopic Lumbar Discectomy? A Historical Control Study of Daytime Operation with a 8‐Hour Hospital Stay versus Inpatient Operation

“…We also found that young patients in the FELD-D group were able to return to work earlier than those in the FELD-I group (p < 0.001). Kou et al 3 believed that day surgery mode could significantly reduce length of hospital stays and relieve the perioperative physical and psychological stress, allowing patients to exercise and return to normal life earlier. These above advantages indicates that day surgery is more suitable for young LDH patients.…”

“…Therefore, recent studies have focused on enhanced recovery after surgery (ERAS) after ELD rather than surgical technique. The ERAS pathway in spine surgery is increasingly popular which can reduce the length of hospital stay without resulting in additional complications after ELD 2,3 . To date, there is lack of a uniform worldwide viewpoint on whether first ambulation time, discharge time, or time of return to work after ELD affects the clinical efficacy and recurrence rate.…”

“…The ERAS pathway in spine surgery is increasingly popular which can reduce the length of hospital stay without resulting in additional complications after ELD. 2 , 3 To date, there is lack of a uniform worldwide viewpoint on whether first ambulation time, discharge time, or time of return to work after ELD affects the clinical efficacy and recurrence rate. Some experts believed that early ambulation may be one of the factors affecting recurrence after ELD.…”