Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Orthopedics, Peking University Third Hospital, Beijing, China.
Orthop Surg. 2023 Sep;15(9):2354-2362. doi: 10.1111/os.13814. Epub 2023 Jul 31.
Full-endoscopic lumbar discectomy (FELD) is a popular operation for the treatment of lumbar disc herniation (LDH) and day surgery mode is increasingly popular. However, only a few studies have reported about day surgery patients undergoing Percutaneous endoscopic lumbar discectomy (PELD). This retrospective study was to evaluate and analyze the clinical outcomes of patients undergoing FELD for LDH as day surgery versus inpatient surgery.
From January 2020 to January 2022, a retrospective analysis of LDH patients treated with FELD either in day surgery unit (within 8-h hospital stay) or inpatient unit was carried out. All these patients were followed-up for at least 12 months, and were categorized into a FELD-I (inpatient surgery) group or a FELD-D (day surgery) group, according to where the surgical procedures were performed. We assessed and compared the postoperative stand and walk time, postoperative hospitalization stays, time of return to work, modified MacNab criteria, willingness to recommend surgery, complications, revision rate, as well as the visual analogue scale (VAS) and the Oswestry disability index score (ODI). Student t-test was used for continuous variables and chi-square test or Fisher's exact test was used for categorical variables.
There was no statistically significant difference in demographic data and baseline characteristics between two groups. And no significant differences were found in MacNab criteria between two groups. Postoperative VAS and ODI scores at one-day postoperation and final follow-up both improved significantly in both groups, as compared to the preoperative data (p < 0.001). However, no significant difference was found between the two groups on the pre, postoperative, or the last follow-up score for VAS and ODI (p > 0.05). The postoperative first ambulation time and postoperative hospital stays was much longer in FELD-I group than FELD-D group (p < 0.001). However, there were no significant differences in the perioperative complications, revision rate as well as satisfaction rate between two groups (p > 0.05). The overall time of return to work of young patients (<60 years-old) in the FELD-D group was significantly shorter than that in the FELD-I group (p = 0.001). Patients in the FELD-D group were more likely to recommend this kind of surgical model.
These data suggest that FELD-D can be effectively performed as day surgery (within 8 h hospital stay). Early ambulation after FELD-D did not affect the clinical outcomes and the revision rates. Day surgery patients are more likely to recommend this surgery mode to other patients and younger patients may be able to return to work earlier.
全内镜下腰椎间盘切除术（FELD）是治疗腰椎间盘突出症（LDH）的一种流行手术，日间手术模式越来越流行。然而，只有少数研究报道了经皮内镜下腰椎间盘切除术（PELD）的日间手术患者。本回顾性研究旨在评估和分析 FELD 治疗 LDH 患者作为日间手术与住院手术的临床效果。
本研究回顾性分析了 2020 年 1 月至 2022 年 1 月期间在日间手术单元（8 小时内住院）或住院单元接受 FELD 治疗的 LDH 患者。所有这些患者都至少随访了 12 个月，并根据手术地点将其分为 FELD-I（住院手术）组或 FELD-D（日间手术）组。我们评估并比较了术后站立和行走时间、术后住院时间、恢复工作时间、改良 MacNab 标准、手术推荐意愿、并发症、翻修率，以及视觉模拟评分（VAS）和 Oswestry 残疾指数评分（ODI）。连续变量采用 Student t 检验，分类变量采用卡方检验或 Fisher 确切概率法。
两组患者的人口统计学数据和基线特征无统计学差异。两组间 MacNab 标准无显著差异。两组术后 1 天和末次随访时 VAS 和 ODI 评分均较术前显著改善（p<0.001）。然而，两组间 VAS 和 ODI 的术前、术后或末次随访评分均无显著差异（p>0.05）。FELD-I 组术后首次活动时间和术后住院时间明显长于 FELD-D 组（p<0.001）。然而，两组间围手术期并发症、翻修率和满意度无显著差异（p>0.05）。FELD-D 组年轻患者（<60 岁）的总体工作恢复时间明显短于 FELD-I 组（p=0.001）。FELD-D 组的患者更有可能推荐这种手术模式。
这些数据表明，FELD-D 可有效作为日间手术（8 小时内住院）进行。FELD-D 术后早期活动不会影响临床效果和翻修率。日间手术患者更有可能向其他患者推荐这种手术模式，年轻患者可能更早恢复工作。
