Asian Spine J.  2019 Oct;13(5):721-729. 10.31616/asj.2018.0268.

Feasibility and Safety of Outpatient Lumbar Microscopic Discectomy in a Developing Country

• Jaiswal A
• Kumar S
• Reddy S
• Jaiswal P

• KMID: 2462000
• DOI: http://doi.org/10.31616/asj.2018.0268

Abstract

STUDY DESIGN: Prospective study. PURPOSE: To verify the feasibility and safety of outpatient microscopic lumbar discectomy (MLD) in a developing country. OVERVIEW OF LITERATURE: Outpatient MLD is advantageous in terms of cost effectiveness and avoidance of nosocomial infections. Safety of outpatient MLD has been well established in the developed nations of North America and Europe. There is no published study of outpatient MLD from the rest of the world, especially in developing countries.
METHODS
Fifty-eight consecutive patients undergoing outpatient MLD with a median follow-up time of 12 months (range, 6-21 months) were included in this study. Simultaneous patient counseling was done by a surgical and anesthetic team preoperatively and pre-discharge. We collected and analyzed data pertaining to the demography, socioeconomic status, perioperative parameters, complications, and outcome assessment scores of the patients.
RESULTS
The average patient age was 37.8±9.6 years (39 males, 19 females). Unilateral discectomy was performed in 55 patients, and bilateral discectomy in three. The majority (80.3%) of the patients were classified to lower middle (III) or upper lower (IV) class on the Modified Kuppuswamy Scale. The average operative time was 41.0±8.4 minutes with an average blood loss of 42.6±14.9 mL. The average postoperative stay was 5.5±0.7 hours and the successful discharge rate was 100%. Complications noted were postoperative nausea (n=8), urinary retention (n=2), meralgia paresthetica (n=3), delayed wound healing (n=2), and recurrence (n=1). The successful outcome rates were Visual Analog Scale (VAS) score leg pain, 93.1%; VAS score back pain, 89.6%; Oswestry Disability Index score, 91.3%; return to activities of daily living, 94.8%; return to work, 79.3%; patient satisfaction rate, 82.7%; and overall success rate, 88.4%.
CONCLUSIONS
Outpatient MLD can be safely performed with success, even in the setting of a developing country, if the prerequisites of appropriate patient selection, arduous adherence to outpatient surgery protocol, competent surgical/anesthetic team, and infrastructure needed for conduction of microsurgery are met.

Keyword

Discectomy; Minimally invasive surgical procedures; Ambulatory surgical procedures; Developing countries

MeSH Terms

Activities of Daily Living
Ambulatory Surgical Procedures
Back Pain
Cost-Benefit Analysis
Counseling
Cross Infection
Demography
Developed Countries
Developing Countries*
Diskectomy*
Europe
Follow-Up Studies
Humans
Leg
Male
Microsurgery
Minimally Invasive Surgical Procedures
North America
Operative Time
Outpatients*
Patient Satisfaction
Patient Selection
Postoperative Nausea and Vomiting
Prospective Studies
Recurrence
Return to Work
Social Class
Urinary Retention
Visual Analog Scale
Wound Healing