Success and Safety in Outpatient Microlumbar Discectomy

Abstract

Currently, many spine surgeons perform microlumbar discectomies on an outpatient basis. Yet, it is often customary for patients to have a 1-night stay in the hospital. Many studies have shown the efficacy of microlumbar discectomy (MLD) and its preference among surgeons for the treatment of lumbar disc herniation. It has also been shown to be safe, successful, and cost-effective. However, a large comprehensive study of this magnitude, gauging safety, success, and patient satisfaction for these procedures on an outpatient basis has not yet been done. One thousand three hundred seventy-seven MLD procedures have been done from 1992 to 2001 by 1 surgeon. A retrospective chart review was done on all procedures. Patients were then contacted by either telephone or mail to complete an outcome questionnaire. Seven hundred thirteen patients (53.9%) completed the questionnaire. Follow-up questionnaires were not completed due to deaths, incorrect contact information, and refused responses. Out of all MLD procedures, 55 (4.0%) were done with a hospital stay-only 24 of these (1.7%) were originally intended outpatient procedures. Of those that were done on an outpatient basis, 8.6% had a complication, including 6.4% who had a recurrent disc herniation. When asked, 81.6% said they would undergo the procedure again as an outpatient. In 82.1% the surgery's outcome was good, very good, or excellent. MLD is a routine procedure that can be performed on an outpatient basis safely, successfully, and with high patient satisfaction.

Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

“…A large study performed by a single orthopedic spine surgeon demonstrated an admission rate of 1.7%. 13 This is consistent with the 1.2% admission rate amongst the spine surgeons in this study. The most valuable measure of admission rates for the purpose of this study would be to isolate those that were secondary to a surgical complication.…”

“…A key factor influencing early discharge of patients undergoing outpatient microdiscectomy is anesthetic complications such as pain, nausea, vomiting and ocular complications. [12][13][14] Occasionally, patients are admitted due to social reasons such as lack of caregiver at home. 8 Admission rates can also be largely influenced by the individual surgeon's comfort level.…”

Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases

“…Given that many studies have proved ASCs produce cost savings with equivalent safety compared with hospitals, any perceived conflict of interest related to the financial relationship of physicians to ASCs must be considered in light of the confluence of interest among stakeholders created by such efficiencies. 1,6,11,16,22 Our initial experience with 1-and 2-level outpatient ACDF surgery in patients with ASA Class I and Class II provided experience and evidence to support the adoption of outpatient ACDF only under specific parameters. Presently, patients who may require conversion to corpectomy due to ossification of the posterior longitudinal ligament or migrated disc fragments, those who require revision ACDF and neck dissection through scar tissue, or those with comorbidities related to altered airway or neck anatomy are not considered for outpatient ACDF regardless of ASA classification.…”

“…6,8,10,18 Evidence is growing that supports the safety and effectiveness of ASCs for lumbar decompression and discectomy; however, evidence for the safety and value of outpatient ACDF remains scarce. [1][2][3]16,20,25 Although short-term costs to health care providers, third-party payers, and health care purchasers tend to be lower in ASCs, cost savings will only be realized across the entire outpatient care episode if that care is associated with surgical safety on par with safety in inpatient settings. Cheaper surgical care up front will lose its value if associated with decreased safety and elevated downstream costs of complications and readmissions.…”

Quality analysis of anterior cervical discectomy and fusion in the outpatient versus inpatient setting: analysis of 7288 patients from the NSQIP database

“…[1][2][3]11,14,19 Surgical costs to the health care provider, the third-party payer, and the health care purchaser are less in the ASC setting, but these cost savings will only be realized across the care episode if the ASC setting provides equivalent (or superior) surgical quality. Therefore, the demonstration of equivalent surgical safety and quality is necessary to determine the relative value (quality/cost) of outpatient versus inpatient ACDF.…”