30-day complication rates and patient-reported outcomes following day case primary lumbar microdiscectomy in a regional NHS spinal centre

Abstract

Advances in surgical and anaesthesia technique have reduced length of stay for lumbar discectomy. Current evidence suggests that daycase surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. We present our microdiscectomy daycase protocol, together with 30-day postoperative complication rates and patient reported outcomes in an NHS setting. We retrospectively studied all patients that met a locally agreed daycase protocol for lumbar microdiscectomy and were operated upon and discharged on the same calendar day between 1 March 2013 and 31 December 2015. A total of 134 patients underwent primary daycase microdiscectomy (70 males, 64 females). The cohort had a mean age of 41 years (range 16-82 years). Some 96% (n=129) were single-level procedures, 93% were unilateral (n=125) and 81% (n=109) took place at either L4/L5 or L5/S1. All patients were discharged on the same day as admission and operation. Four patients re-presented to hospital within 30 days and three were discharged from the emergency department within four hours following a clinical review. One patient required an inpatient stay for a washout of a superficial postoperative infection. Significant improvements (P<0.05) were found postoperatively for back pain and leg pain on self-reported visual analogue scores and Oswestry Disability Index. In this study, we present a safe and effective protocol for day case lumbar microdiscectomy. Our 30-day postoperative complication rate of under 1% is comparable to that of traditional inpatient primary lumbar microdiscectomy. Patient-reported outcome measures revealed significant improvement in both pain and functional scores.