Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

Ahuja, Neeraj; Sharma, Himanshu

doi:10.1016/j.surge.2017.04.001

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…An amalgamation of all these measures ensured that we did not encounter any case of postoperative anxiety, which was identified as an important reason for discharge failure. Minimizing intraoperative soft tissue dissection, adequate perioperative multimodal analgesia, and wound infiltration with bupivacaine before skin closure alleviated the issue of postoperative pain [3]. The incidence of PONV was 13.7% in our study, but none of these cases were severe enough to affect patient discharge.…”

Section: Discussionmentioning

confidence: 69%

“…However, our study was a pilot study in the setting of a developing country; thus, we only included patients between 18–55 years. Some studies have stated that previous lumbar surgery, multilevel lesions, or a need to do bilateral MLD is a contraindication for outpatient MLD [2,3,5]. However, many authors have safely conducted this procedure in these previously excluded cases [7,11,13,15,16,19].…”

Section: Discussionmentioning

confidence: 99%

“…The success of any outpatient surgery depends on the ability to successfully discharge patients with minimal complications. An exhaustive literature review was performed prior to the inception of this study to determine possible causes of discharge failure (Table 3), and we found that patient anxiety [2,15], postoperative pain [3,5,7,9-11,14,19], PONV [3,7,10,11,13,15,17,18], POUR [3,7,10,11,13-15,17], and dural tear [3,7,9-11,13,18,19] were the commonly stated reasons for discharge failure (Table 3). Appropriate patient selection is the cornerstone of outpatient MLD, with proper indication and patient acceptability being the key factors.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

et al. 2019

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Study DesignProspective study.PurposeTo verify the feasibility and safety of outpatient microscopic lumbar discectomy (MLD) in a developing country.Overview of LiteratureOutpatient MLD is advantageous in terms of cost effectiveness and avoidance of nosocomial infections. Safety of outpatient MLD has been well established in the developed nations of North America and Europe. There is no published study of outpatient MLD from the rest of the world, especially in developing countries.MethodsFifty-eight consecutive patients undergoing outpatient MLD with a median follow-up time of 12 months (range, 6–21 months) were included in this study. Simultaneous patient counseling was done by a surgical and anesthetic team preoperatively and pre-discharge. We collected and analyzed data pertaining to the demography, socioeconomic status, perioperative parameters, complications, and outcome assessment scores of the patients.ResultsThe average patient age was 37.8±9.6 years (39 males, 19 females). Unilateral discectomy was performed in 55 patients, and bilateral discectomy in three. The majority (80.3%) of the patients were classified to lower middle (III) or upper lower (IV) class on the Modified Kuppuswamy Scale. The average operative time was 41.0±8.4 minutes with an average blood loss of 42.6±14.9 mL. The average postoperative stay was 5.5±0.7 hours and the successful discharge rate was 100%. Complications noted were postoperative nausea (n=8), urinary retention (n=2), meralgia paresthetica (n=3), delayed wound healing (n=2), and recurrence (n=1). The successful outcome rates were Visual Analog Scale (VAS) score leg pain, 93.1%; VAS score back pain, 89.6%; Oswestry Disability Index score, 91.3%; return to activities of daily living, 94.8%; return to work, 79.3%; patient satisfaction rate, 82.7%; and overall success rate, 88.4%.ConclusionsOutpatient MLD can be safely performed with success, even in the setting of a developing country, if the prerequisites of appropriate patient selection, arduous adherence to outpatient surgery protocol, competent surgical/anesthetic team, and infrastructure needed for conduction of microsurgery are met.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

et al. 2019

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“…Despite an abundance of evidence from the United States, the uptake of day case spinal surgery in the UK has been slower and it remains relatively uncommon (Ahuja & Sharma 2018). For example, a recent review of spinal services in the UK suggests that day case rates for lumbar discectomy fall significantly below benchmark levels (Hutton 2019).…”

Section: Discussionmentioning

confidence: 99%

“…In the case of lumbar microdiscectomy, it has also recently been shown to be more cost-effective (Linhares et al 2021). Despite these proven benefits, uptake in the UK remains low (Ahuja & Sharma 2018).…”

Section: Introductionmentioning

confidence: 99%

Adopting the day surgery default in the provision of lumbar discectomy and decompressive surgery

Paluch

Matthews

Mullins

et al. 2022

Journal of Perioperative Practice

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Introduction Provision of day case spinal procedures in the UK is below expected standards and there is a need for the creation of guidance and patient pathways to address this. Here we present a day case lumbar discectomy protocol and evaluate its impact at our institution. Methods A new pathway (incorporating defined selection criteria, patient education, anaesthetic protocol and discharge prescriptions) was implemented for all suitable patients within a single surgeon’s cohort. Day case rates for lumbar discectomy were compared before and after implementation. Patient feedback was collated using a patient-reported experience measure. Results Eighteen of 23 patients selected as suitable via the pathway successfully underwent day surgery, leading to an increase in lumbar discectomy day case rates from 25% to 69% at our institution. Nearly all patients were satisfied with their experience, although a significant proportion felt provision of postoperative analgesia could be improved. Conclusion We present a day surgery pathway for lumbar discectomy that is safe and effective. This could be more widely implemented to increase day case rates.

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Factors influencing peri-operative delays in neurosurgery operating theatres: a prospective study

Chaganty

Sharma

2021

Perioperative Care and Operating Room Management

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Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

Cited by 7 publications

References 20 publications

Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

Adopting the day surgery default in the provision of lumbar discectomy and decompressive surgery

Factors influencing peri-operative delays in neurosurgery operating theatres: a prospective study

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