Outcome of hospital discharge on postoperative Day 1 following uncomplicated tethered spinal cord release

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Postoperative management following the release of simple spinal cord–tethering lesions is highly variable. As a quality improvement initiative, the authors aimed to determine whether an institutional protocol of discharging patients on postoperative day (POD) 1 was associated with a higher rate of postoperative CSF leaks than the prior protocol of discharge on POD 2.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This was a single-center retrospective review of all children who underwent release of a spinal cord–tethering lesion that was not associated with a substantial fascial or dural defect (i.e., simple spinal cord detethering) during 2 epochs: prior to and following the institution of a protocol for discharge on POD 1. Outcomes included the need for and timing of nonroutine care of the surgical site, including return to the operating room, wound suturing, and nonsurgical evaluation and management.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of 169 patients identified, none presented with CSF-related complications prior to discharge. In the preintervention group (n = 113), the postoperative CSF leak rate was 4.4% (5/113). The mean length of stay was 2.3 days. In the postintervention group, the postoperative CSF leak rate was 1.9% (1/53) in the patients with postdischarge follow-up. The mean length of stay in that group was 1.3 days.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>At a single academic children's hospital, a protocol of discharging patients on POD 1 following uncomplicated release of a simple spinal cord–tethering lesion was not associated with an increased rate of postoperative CSF leaks, relative to the previous protocol. The rates identified are consistent with the existing literature. The authors' practice has changed to discharge on POD 1 in most cases.</jats:p></jats:sec>

Comparison of the Inter-laminar Approach and Laminotomy Open Approach for Filum Terminale Lipoma: A Retrospective Analysis

“…This was attributed to the fact that postoperative pain was less with the ILA technique. In our study, the rates of postoperative complications requiring reoperation were 1.8% and 2.0% in the ILA and LOA groups, respectively, which were lower than those in previous reports [2,5,6,10,14,20,21,25,31].…”

“…Bhimani et al [2] reported a complication rate of 8.1% with a single laminotomy. Complication rates in other studies were 1.8-9.2% [5,10,14,20,21,31].…”

Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study

“…Ample studies have examined the optimal duration that patients should remain flat in the context of simple tethered cord, but no quality prospective studies have analyzed this factor for complex tethered cords. 23,24,28,29 Consensus was reached for a minimum duration of 24 hours of flat positioning postoperatively (94.14% agree or strongly agree). A significant proportion of the group kept patients flat for 48 hours or more, but not at a level sufficient for consensus.…”