Provision of day case spinal procedures in the UK is below expected standards and there is a need for the creation of guidance and patient pathways to address this. Here we present a day case lumbar discectomy protocol and evaluate its impact at our institution.
Methods
A new pathway (incorporating defined selection criteria, patient education, anaesthetic protocol and discharge prescriptions) was implemented for all suitable patients within a single surgeon’s cohort. Day case rates for lumbar discectomy were compared before and after implementation. Patient feedback was collated using a patient-reported experience measure.
Results
Eighteen of 23 patients selected as suitable via the pathway successfully underwent day surgery, leading to an increase in lumbar discectomy day case rates from 25% to 69% at our institution. Nearly all patients were satisfied with their experience, although a significant proportion felt provision of postoperative analgesia could be improved.
Conclusion
We present a day surgery pathway for lumbar discectomy that is safe and effective. This could be more widely implemented to increase day case rates.
Abou-ZeidAPalmerJGnanalinghamK2014Day case lumbar discectomy – viable option in the UK?British Journal of Neurosurgery28 (3) 320–323
2.
AhujaNSharmaH2018Lumbar microdiscectomy as a day-case procedure: scope for improvement?Surgeon16 (3) 146–150
3.
AnsellGLMontgomeryJE2004Outcome of ASA III patients undergoing day case surgeryBritish Journal of Anaesthesia92 (1) 71–74
4.
Bailey CR, Ahuja M, Bartholomew K et al 2019Guidelines for day-case surgery 2019: guidelines from the Association of Anaesthetists and the British Association of Day SurgeryAnaesthesia74 (6) 778–792
5.
Basques BA, Varthi AG, Golinvaux NS, Bohl DD, Grauer JN 2014Patient characteristics associated with increased postoperative length of stay and readmission after elective laminectomy for lumbar spinal stenosisSpine39 (10) 833–840
6.
BestNMSassoRC2007Outpatient lumbar spine decompression in 233 patients 65 years of age or olderSpine32 (10) 1135–1139
7.
British Association of Day Surgery2016BADS Directory of Procedures5th ednLondon,
British Association of Day Surgery
8.
Charipova K, Gress KL, Urits I, Viswanath O, Kaye AD 2020Maximization of non-opioid multimodal analgesia in ambulatory surgery centersCureus12 (9) e10407
9.
ChungFMezeiGTongD1999Adverse events in ambulatory surgery. A comparison between elderly and younger patientsCanadian Journal of Anaesthesia46 (4) 309–321
10.
DaviesKEHoughtonKMontgomeryJE2001Obesity and day-case surgeryAnaesthesia56 (11) 1090–1115
11.
Elaqoul A, Obaid A, Yaqup E et al 2017Postoperative pain among patients after day-case surgeryPlastic Surgical Nursing37 (4) 130–136
12.
Elsarrag M, Soldozy S, Patel Pet al2019Enhanced recovery after spine surgery: a systematic reviewNeurosurgical Focus46 (4) 3
13.
GriffithHMarksC1987Outpatient surgery for prolapsed lumbar discBritish Journal of Neurosurgery1 (1) 105–109
14.
HoggettLAndertonMJKhatriM201930-Day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centreAnnals of the Royal College of Surgeons of England101 (1) 50–54
Idowu OA, Boyajian HH, Ramos E, Shi LL, Lee MJ, et al2017Trend of spine surgeries in the outpatient hospital setting versus ambulatory surgical centerSpine 42 (24) E1429–E1436
17.
Ip HY, Abrishami A, Peng PW, Wong J, Chung F 2009Predictors of postoperative pain and analgesic consumption: a qualitative systematic reviewAnesthesiology111 (3) 657–677
18.
Lang SS, Chen HI, Koch MJet al2014Development of an outpatient protocol for lumbar discectomy: our institutional experienceWorld Neurosurgery 82 (5) 897–901
19.
LevettDZHGrimmettC2019Psychological factors, prehabilitation and surgical outcomes: evidence and future directionsAnaesthesia 74 (1) 36–42
20.
Licina A, Silvers A, Laughlin H, Russell J, Wan C 2021Pathway for enhanced recovery after spinal surgery – a systematic review of evidence for use of individual componentsBMC Anesthesiology21 (1) 1–21
21.
Linhares D, Fonseca J, Ribeiro da Silva M, Conceição F, Sousa A, Sousa-Pinto B, Neves N 2021Cost effectiveness of outpatient lumbar discectomyCost Effectiveness and Resource Allocation19 (1) 1–11
22.
LowMBurgessLCWainwrightTW2019A critical analysis of the exercise prescription and return to activity advice that is provided in patient information leaflets following lumbar spine surgeryMedicina55 (7) 347
23.
LowMBurgessLWainwrightT2020Patient information leaflets for lumbar spine surgery: a missed opportunityJournal of Patient Experience7 (6) 1403–1409
24.
MitchellM2004Pain management in day-case surgeryNursing standard (Royal College of Nursing (Great Britain): 1987) 18 (25) 33–38
25.
NHS Model Hospital2021 Posterior excision of lumbar disc prolapse (including microdiscectomy) Available at: https://model.nhs.uk/metrics (Accessed 28 March 2021)
26.
Nightingale CE, Margarson MP, Shearer E et al2015 Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia 70 (7) 859–876
27.
Peene L, Le Cacheux P, Sauter AR, et al2020Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendationsEuropean Spine Journal 30 (10) 2925–2935
28.
Pendharkar AV, Shahin MN, Ho ALet al2018Outpatient spine surgery: defining the outcomes, value, and barriers to implementationNeurosurgical Focus44(5) E11
29.
Powell R, Scott NW, Manyande Aet al2016Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesiaCochrane Database of Systematic Reviews 26 (5) CD008646
30.
Prabhakar A, Cefalu JN, Rowe JS, Kaye AD, Urman RDet al2017Techniques to optimize multimodal analgesia in ambulatory surgeryCurrent Pain and Headache Reports21 (5) 24
31.
Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes SAet al2013Outpatient surgery reduces short-term complications in lumbar discectomy: an analysis of 4310 patients from the ACS-NSQIP databaseSpine38 (3) 264–271
32.
QuembyDJStockerME2014Day surgery development and practice: key factors for a successful pathwayContinuing Education in Anaesthesia, Critical Care and Pain14 (6) 256–261
33.
RaeA2016Reasons for delayed patient discharge following day surgery: a literature reviewNursing standard (Royal College of Nursing (Great Britain) : 1987) 31 (11) 42–51
34.
RaederJ2020Procedure-specific and patient-specific pain management for ambulatory surgery with emphasis on the opioid crisisCurrent Opinion in Anaesthesiology 33 (6) 753–759
35.
RichebéPBrulotteVRaftJ2019Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgeryCurrent Opinion in Anaesthesiology 32 (6) 720–726
36.
RosenbergerPHJoklPIckovicsJ2006Psychosocial factors and surgical outcomes: an evidence-based literature reviewJournal of the American Academy of Orthopaedic Surgeons 14 (7) 397–405
37.
Roth B, Boateng A, Berken A, Carlyle D, Vadivelu N 2018Post-operative weaning of opioids after ambulatory surgery: the importance of physician stewardshipCurrent Pain and Headache Reports 22 (6) 1–6
38.
ServinF2006Ambulatory anesthesia for the obese patientCurrent Opinion in Anaesthesiology19 (6) 597–599
39.
TownsendRCoxF (2007)
Standardised analgesia packs after day case orthopaedic surgeryJournal of Perioperative Practice 17 (7) 340–346
