Routine perioperative practices and postoperative outcomes for elective lumbar laminectomies

Abstract

Background: Routine investigations for asymptomatic patients undergoing low-risk surgery contribute little value to perioperative care, but these tests are still ordered in many centres. The primary purpose of this retrospective cohort study was to determine the prevalence of preoperative bloodwork for elective lumbar laminectomy and its association with intraoperative and postoperative complications. Secondary objectives were to determine the prevalence of intraoperative tranexamic acid administration, length of stay, and 30-day readmission. Methods: Retrospective electronic chart reviews were conducted on all patients 18+ years old who underwent elective lumbar laminectomy by one orthopaedic spine surgeon between July 01, 2013 and June 30, 2017. All procedures were performed at the University Health Sciences Centre. Results: Two hundred fifty-six patients underwent lumbar laminectomy at one or more levels during the study period. Among these patients, 89.5% underwent at least one preoperative blood test. The intraoperative complication rate was 2.34%. Intraoperative intravenous tranexamic acid was administered in <2% of surgeries; there were no postoperative blood transfusions. The 30-day hospital readmission rate was zero. Conclusions: Hospital policies should be re-evaluated to address the overuse of unnecessary preoperative investigations for elective lumbar laminectomies, which have low perioperative transfusion and complication rates.

Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design

“…19 20 Finally, a retrospective review of patients undergoing elective lumbar laminectomy between 2013 and 2017 by a single surgeon at Queen's University Health Sciences Centre in Ontario found that 89.5% of patients underwent at least one preoperative blood test. 21 Similar figures have been reported internationally. 12 22-24 An assessment of data from Newfoundland's 10 surgical sites is underway and will indicate the scope of the problem in our local context.…”