A prospective comparative study between day care spine surgery and conventional spine surgery

Abstract

Background: Day care spine surgery though practiced in many centers around the world, is still relatively an unchartered territory here in India, with very few centers performing spine surgeries in a day care setup. Our study was conducted to assess the feasibility of day care spine surgery in our setup. Materials and Methods: This is a prospective observational study in which patients who had undergone spinal surgery (lumbar discectomies, intradural-extramedullary lesions [IDEMs] and extradural space-occupying lesions [SOLs] extending up to one and a half vertebral levels, and one or two level anterior cervical discectomy and fusion [ACDF] in a day care setting) in our department from March 2018 to December 2018, were recruited. Of the 68 patients recruited, 33 were in the day care group and 35 were in the routine group. Data was collected on type of pathology, comorbidities, spinal segment involved, type of surgical procedure; visual analog scale (VAS) score in the preoperative period, immediately after surgery, 12h after the discharge, and at suture removal, length of hospital stay, cost, conversion of the day care to a routine admission, and disability/functional outcome. Results: We found comparable surgical results and postoperative pain profile in both the groups; median VAS in the immediate post-op period was found to be 5 in the day care and 4 in the routine group, at 12h after discharge, it was found to be 4 in both the groups, and at suture removal, it was found to be 2 in both the groups. There was statistically significant decrease in hospital stay and cost with a P value of 0.001 for both. Mean length of hospital stay was 1.15 ± 0.36 days in the day care and 9.66 ± 4.76 in the routine group. Mean cost was 2142.97 rupees in the day care, whereas it was 17971.94 rupees in the routine group. There were no new onset neurological deficits in the day care group. Five cases were converted from the day care group due to various reasons. Conclusion: One and two level lumbar prolapsed intervertebral discs (PIVDs)/canal stenosis, cervical PIVDs, especially single-level PIVD, IDEMs, and extradural SOLs can be performed in a day care setting.