Abstract
Introduction
This study is to assess the safety of day case lumbar decompressive surgery.
Patients and Method: Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database.
Results
Between January 2011 and April 2014, 131 open and 102 microscopic surgeries were done in patients with mean age of 46 (range, 16–88) years and male:female ratio of 136 (59%):97 (41%). Inclusion criteria were no known anesthetic reaction, ASA grade I or II, BMI < 35 mg/kg2, less than 30 minutes travel time, and responsible home care. Patients were discharged after clinical assessment with cauda equina advice and emergency contact number. A total of 215 (92%) procedures were single level, of which 188 (87%) unilateral and 27 (13%) were bilateral procedures. Overall, 18 (8%) procedures were multiple levels, of which 12 (67%) were unilateral and 6 (33%) were bilateral procedures. Majority, 107 (50%), 97 (45%) procedures were done at L5/S1 and L4/L5 levels, respectively, and rest 11 (5%) at higher level. The 7-day and 30-day representation figures were 7 (3%) and 15 (6.4%) that are as follows: pain (n = 3), medication (n = 2), wound issues (n = 5), infection (n = 2), headache (n = 2), and VTE (n = 1). Overall, 11 patients were sent home and 4 (1.7%) were admitted with two requiring further surgery, one revision discectomy and one wound washout. No cauda equina or compressive hematoma were encountered.
Conclusion
This study demonstrates that open and microscopic lumbar discectomy at single or multiple levels can be performed safely as a day case procedure. The representation rate to the ED can be potentially reduced by better advice and pain management.