Outpatient Surgery Reduces Short-Term Complications in Lumbar Discectomy

Abstract

After adjusting for confounders using propensity score matching and multivariate logistic regression analysis, patients undergoing outpatient lumbar discectomy had lower overall complication rates than those treated as inpatients. Surgeons should consider outpatient surgery for lumbar discectomy in appropriate candidates.

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

“…Despite the definitional differences, certain past orthopaedic data set studies relied on the nebulous ''inpatient''/ ''outpatient'' NSQIP variable in their analysis as opposed to LOS[0/LOS = 0 [32,35,41,50]. When a comparison was done using admission status as a predictor of adverse events after THA, an ''inpatient'' assignment in comparison to an ''outpatient'' assignment was found to be associated with an increased risk of any adverse event, SAE, and readmission (Fig.…”

“…Multiple studies in orthopaedics have used NSQIP, a large national database that provides an ''outpatient'' status variable, to study outpatient procedures without determining what, exactly, ''outpatient'' means in NSQIP [32,35,41]. Under current regulations in the United States, patients who underwent outpatient surgery may stay one or more nights at the hospital under ''observation'' status despite being coded as an outpatient [38].…”

“…Matching without replacement has been used to create matched cohorts for comparison of outpatient and inpatient orthopaedic procedures before. This type of matching tends to reduce bias toward poorer outcomes for the inpatient cohort [32,41]. Two distinct sets of multivariate analyses, utilizing Poisson regressions with robust error variance, were then performed to calculate the relative risks of three adverse event classes and readmission for patients who underwent THA who had ''inpatient'' surgery relative to ''outpatient'' surgery and who had LOS [ 0 relative to LOS = 0 [52].…”

“…Many studies in different surgical subspecialties have used this variable to compare short-term outcomes of inpatient versus outpatient surgery [19-22, 27, 28, 33, 34, 36, 39, 42-46]. Multiple recent studies in orthopaedics have used these variables to study outpatient procedures or have included these variables in their studies as well [32,35,41,50]. However, in NSQIP, the ''inpatient'' or ''outpatient'' variable is distinct from the hospital length of stay (LOS) variable [1].…”

A wandering intravascular scalpel fragment after lumbar discectomy: a case report

“…The vascular complication rate after lumbar discectomy is approximately 1-5/10,000, which is rare compared to after vascular surgery (6,4). Major vascular injuries require prompt diagnosis and emergency treatment because of a reported mortality rate of more than 40% (4,7).…”