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Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients

Published online by Cambridge University Press:  02 December 2014

Ashutosh Singhal
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
Mark Bernstein
Affiliation:
Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract

Background:

Outpatient surgery saves the risk of nosocomial complications and health care dollars. Patients undergoing lumbar microsurgical discectomy are excellent candidates for outpatient surgery. The object of this study was to examine the feasibility of performing lumbar microdiscectomy on an outpatient protocol and to examine the potential savings associated with such a protocol.

Methods:

From February 1997 to September, 2001, 122 consecutive patients of the senior author were entered into a protocol of outpatient lumbar microdiscectomy. Only elective cases were considered for this study. Patients were excluded if they had significant co-morbidities, lived a significant distance out of town, or if their surgery was scheduled too late in the day. Success was defined as discharge home from the day-surgery unit approximately four hours after surgery.

Results:

During the study period, 150 elective lumbar microdiscectomies were performed. Twenty-four patients were excluded based on the above criteria and four patients requested not to participate in the study. Of the remaining 122, 116 successfully completed the protocol (95.1%). Six patients were admitted from the day surgery unit; two patients with dural tears and four patients with anaesthetic side-effects. No patient was readmitted to hospital after discharge and no complications of early discharge were observed. There was a total reduction in hospitalization of 1.2 nights per elective procedure considering the 150 patients, when compared with the hospitalization times prior to outpatient lumbar microdiscectomy.

Conclusion:

Lumbar microdiscectomy can be performed safely as an outpatient procedure, resulting in a substantial reduction in hospitalization times.

Résumé:

RÉSUMÉ: Introduction:

La chirurgie ambulatoire diminue le risque de complications opportunistes et les coûts de santé. Les patients qui subissent une iscectomie lombaire par microchirurgie sont d’excellents candidats à la chirurgie ambulatoire. Le but de cette étude était d’examiner la aisabilité d’un protocole de microdiscectomie lombaire effectuée en externe et la diminution des coûts associés.

Méthodes:

122 patients consécutifs de l’auteur sénior ont été admis à ce protocole entre février 1997 et septembre 2001. Seulement les cas électifs étaient éligibles. Les critères d’exclusion étaient: une co-morbidité importante, un lieu de résidence éloigné et une chirurgie prévue en fin de journée. Le succès était défini comme un congé de l’unité chirurgicale environ quatre heures après la chirurgie.

Résultats:

Pendant la période de l’étude, 150 microdiscectomies lombaires ont été effectuées. Quarante-quatre patients ont été exclus sur la base des critères mentionnés précédemment et quatre patients ne désiraient pas participer à l’étude. Des 122 autres patients, 116 ont complété vec succès le protocole (95,1%). Six patients ont été hospitalisés, soit deux patients ayant présenté une déchirure durale et quatre patients ayant présenté des effets secondaires de l’anesthésie. Aucun patient n’a été réadmis après le congé de l’unité de chirurgie ambulatoire et ucune complication n’a été observe suite au congé. Dans l’ensemble cette façon de procéder a réduit l’hospitalisation de 1,2 nuits par chirurgie élective chez ces 150 patients, par rapport au temps d’hospitalisation avant l’implantation de la microdiscectomie lombaire ambulatoire.

Conclusions:

La microdiscectomie lombaire peut être effectuée en externe sans compromettre la sécurité des patients, ce qui diminue substantiellement le temps d’hospitalisation.

Type
Research Article
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

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