Debono Bertrand, Sabatier Pascal, Garnault Valérie, Hamel Olivier, Bousquet Philippe, Lescure Jean-Paul, Plas Jean-Yves
Neurosurgery Department, CAPIO - Clinique des Cèdres, Cornebarrieu, France.
Neurosurgery Department, CAPIO - Clinique des Cèdres, Cornebarrieu, France.
World Neurosurg. 2017 Oct;106:891-897. doi: 10.1016/j.wneu.2017.07.065. Epub 2017 Jul 20.
The outpatient lumbar discectomy procedures have been established for more than 2 decades. However, especially in Europe, there are still obstacles to the development of these procedures, which may be related to medicoeconomic imperatives, and to several factors concerning both surgeons and patients. We describe our initial experience in introducing this method in our institution.
During a 3-year period, 201 patients met the criteria for ambulatory lumbar microdiscectomy. A dedicated fast-tracking unit provided preoperative patient education and immediate postoperative follow-up. A surgical consultation was organized 6 weeks after surgery, and a late satisfaction phone survey concerning ambulatory management was carried out after 6 months.
The average total inpatient time was 10 hours and 12 minutes. One patient (0.5%) remained overnight because of an anxiety attack. No patients contacted the FT unit during the first night, and no complications occurred. All patients were reviewed in consultation around day 45: the average visual analog scale score was significantly reduced. At this early postoperative follow-up, 87.5% of patients were (very) satisfied with this procedure. At the day 180 survey, average visual analog scale scores were not significantly different from the day 45 data. In terms of return to normal activities of daily living, 120 patients (60%) had no limitation, 72 patients (36%) had minor or major limitations, and 8 (4%) were incapacitated. At this final evaluation, 8% of patients (n = 16) were very satisfied, 73% were satisfied (n = 146), 11% (n = 22) were partly satisfied, and 8% (n = 16) were not satisfied with the outpatient procedure.
Reducing hospitalization for lumbar discectomies to a few hours is not a reduction in the quality of care. It is not necessarily simple to overcome the resistances of all protagonists, but placing the patient as the main actor of an integrated management plan is the key to transforming a medicoeconomic incentive into a clinical success.
门诊腰椎间盘切除术已开展二十多年。然而，尤其是在欧洲，这些手术的发展仍存在障碍，这可能与医疗经济需求以及与外科医生和患者相关的若干因素有关。我们描述了在本机构引入该方法的初步经验。
在3年期间，201例患者符合门诊腰椎显微椎间盘切除术的标准。一个专门的快速跟踪单元提供术前患者教育和术后即时随访。术后6周组织手术咨询，并在6个月后进行关于门诊管理的晚期满意度电话调查。
平均总住院时间为10小时12分钟。1例患者（0.5%）因焦虑发作而留院过夜。第一晚无患者联系快速跟踪单元，且未发生并发症。所有患者在术后约45天接受复查：平均视觉模拟量表评分显著降低。在术后早期随访中，87.5%的患者对该手术（非常）满意。在第180天的调查中，平均视觉模拟量表评分与第45天的数据无显著差异。在恢复正常日常生活方面，120例患者（60%）无限制，72例患者（36%）有轻微或严重限制，8例（4%）丧失能力。在最终评估中，8%的患者（n = 16）非常满意，73%的患者（n = 146）满意，11%（n = 22）部分满意，8%（n = 16）对门诊手术不满意。
将腰椎间盘切除术的住院时间缩短至数小时并不会降低护理质量。克服所有相关方的阻力并非易事，但将患者作为综合管理计划的主要参与者是将医疗经济激励转化为临床成功的关键。
