Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P138. Outpatient lumbar discectomy has significantly lower postoperative surgical wound infection and postoperative infection rates in tobacco use disorder and diabetes mellitus patients

Abstract

BACKGROUND CONTEXT Outpatient lumbar discectomy has seen an increase in recent years. Outpatient setting is considered safe and cost effective procedure for lumbar discectomy. However, the safety of outpatient lumbar discectomyin patients who have tobacco use disorder (TUD) or Diabetes Mellitus (DM) is still not well investigated. PURPOSE The aim of this study was to compare the rates of postoperative complications after lumbar discectomy in TUD and DM patients between outpatient and inpatientsettings. STUDY DESIGN/SETTING Retrospective study using Humana database from 2007 to 2016 (PearlDiver Technologies) (Colorado Springs, CO, USA). PATIENT SAMPLE Patients who underwent lumbar discectomy at any level in outpatient and inpatient setting, from 2007 to the first quarter of 2016. Each patient group was divided based on the comorbidity (TUD or DM). OUTCOME MEASURES The presence of re-exploration within 1 year after index surgery, venous-thombotic event (VTE) within 1 year after surgery, surgical site and postoperative infection within 3 months were evaluated. The VTE was defined as deep vein thrombosis and pulmonary embolism. The postoperative infections were defined as surgical site infection, urinary tract infection, catheter related infection and sepsis-related infection. The surgical site complications were defined as wound disruption, hematoma or seroma at surgical wound and nonhealing surgical wound. METHODS The nationwide Humana private insurance database was queried using International Classification of Diseases 9th edition and Current Procedural Terminology Codes. Patients who underwent lumbar discectomy were subdivided into two groups: inpatient and outpatient setting group. Each group was further stratified by presence or absence of TUD or DM. The occurrence of re-exploration, VTE, infection and surgical wound complications were investigated. The Chi-Square test was used to compare between two setting groups in each complication, the p-value, odd-ratio (OR), and 95% Confidence Interval (95% CI) were calculated.The statistically significant difference level was set at a p-value of less than 0.05. RESULTS A total of 24,407 patients underwent lumbar discectomy procedures. Of these, 69.49% (16,961) of patients received lumbar discectomy in outpatient setting. A total of 2,630 patients had TUD and of those 70.57% (1,856) had the lumbar discectomy in the outpatient setting. Of 24,407 patients 3,511 had DM (65.45% (2,298) outpatient lumbar discectomy). In general, the outpatient setting showed significantly lower incidence of postoperative infection (p CONCLUSIONS Inpatient procedures had a higher rate of surgical-wound related complications, postoperative infections and VTE compared to the outpatient setting. At the same time, the outpatient setting had a higher rate of reoperation at the same lumbar level than inpatient setting. The rate of complications occurrence in TUD and DM outpatients and inpatient lumbar discectomy group was not different from the overall patients.