Patel Dil V, Yoo Joon S, Karmarkar Sailee S, Lamoutte Eric H, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Spine Surg. 2019 Sep;5(Suppl 2):S166-S173. doi: 10.21037/jss.2019.04.05.
There is limited data regarding clinical and surgical outcomes of minimally invasive lumbar decompression (MIS LD) as an outpatient procedure. In this context, our purpose is to evaluate a single surgeon's experience with performing MIS LD in the outpatient versus inpatient setting and determining if there are differences in surgical and clinical outcomes.
Patients undergoing primary, one- to three-level MIS LD were retrospectively reviewed and stratified by surgical setting: ambulatory surgical center (ASC) versus hospital. The cohorts were compared with respect to demographics, perioperative characteristics, complications, postoperative pain and narcotics consumption, and improvements in patient-reported outcomes.
Five hundred and nine patients were included: 332 patients underwent surgery at an ASC and 177 patients underwent surgery at a hospital. The ASC patients were younger, more likely to be male, and carry Workers' Compensation insurance. The hospital patients were older, more likely to be diabetic, and had a greater comorbidity burden. Patients undergoing MIS LD in an ASC were less likely to have multi-level procedures and more likely to have decompression with discectomy compared to patients in the hospital cohort. There were two cases of superficial wound infection in the ASC cohort and a single case of a pulmonary embolus in the hospital cohort. Additionally, a total of 28 patients had recurrent herniated nucleus pulposus in the ASC cohort compared to 12 patients in the hospital cohort. There was one case of residual stenosis in the ASC cohort compared to eight cases in the hospital cohort. Both cohorts demonstrated similar preoperative ODI, VAS back pain, and VAS leg pain scores through 12-month follow-up.
MIS LD is a safe and effective procedure in an ASC, however, appropriate patient selection and postoperative protocols are imperative in minimizing complications and optimizing safety and efficacy in the outpatient setting.
关于门诊微创腰椎减压术（MIS LD）的临床和手术结果的数据有限。在此背景下，我们的目的是评估单一外科医生在门诊与住院环境中进行MIS LD的经验，并确定手术和临床结果是否存在差异。
对接受初次一至三级MIS LD的患者进行回顾性研究，并根据手术环境进行分层：门诊手术中心（ASC）与医院。比较两组患者的人口统计学、围手术期特征、并发症、术后疼痛和麻醉药物使用情况，以及患者报告结局的改善情况。
纳入509例患者：332例在ASC接受手术，177例在医院接受手术。ASC组患者更年轻，男性比例更高，且持有工伤保险。医院组患者年龄更大，糖尿病患病率更高，合并症负担更重。与医院组患者相比，在ASC接受MIS LD的患者进行多节段手术的可能性较小，而进行椎间盘切除术减压的可能性较大。ASC组有2例表浅伤口感染，医院组有1例肺栓塞。此外，ASC组共有28例复发性椎间盘突出症患者，而医院组为12例。ASC组有1例残留狭窄，医院组有8例。两组患者在12个月的随访中，术前ODI、VAS背痛和VAS腿痛评分相似。
MIS LD在ASC中是一种安全有效的手术，但在门诊环境中，必须进行适当的患者选择和术后方案，以尽量减少并发症并优化安全性和有效性。
