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Acute complications in patients with surgical treatment of lumbar herniated disc
J W Kardaun1, L R White, W O Shaffer
1Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, Maryland.
Insights
Surgical treatment for lumbar disc herniation (LDH) has a 3.7% complication rate, with factors like obesity increasing risk. While generally safe, these surgical complications require attention.
Area of Science:
- Neurosurgery
- Public Health
Background:
- Complications from lumbar disc herniation (LDH) surgery are difficult to quantify due to low incidence and varied presentation.
- Understanding these risks is crucial for patient safety and informed treatment decisions.
Purpose of the Study:
- To assess acute complication rates in surgically treated lumbar disc herniation (LDH) patients.
- To identify factors associated with increased complication risk following LDH surgery.
Main Methods:
- Utilized data from the National Hospital Discharge Survey (ICD-9-CM codes).
- Analyzed codiagnoses to identify complications in 3,289 surgically treated LDH patients and 4,025 nonoperative LDH patients.
- Correlated complication rates with postoperative length of stay and patient risk factors (obesity, hypertension, diabetes).
Main Results:
- The overall complication rate for LDH surgery was 3.7%.
- Complication rates significantly correlated with longer postoperative stays and risk factors including obesity, hypertension, and diabetes.
- Reported lower rates of thrombophlebitis (0.3/1,000) and mortality (0.9/1,000) compared to previous literature.
- Cauda equina syndrome incidence was found to be 5/1,000, though pre-existing cases could not be excluded.
Conclusions:
- Lumbar disc herniation surgery is relatively safe, but associated complications should not be disregarded.
- Patient-specific risk factors and postoperative care significantly influence complication occurrence.
- Continued monitoring and reporting of LDH surgical outcomes are essential for improving patient care.
Abstract:
The complications of surgical treatment for lumbar disc herniation (LDH) are important to know, but hard to measure because of their low incidence and varied pattern. Using data from the National Hospital Discharge Survey, which codes discharges and procedures according to the ICD-9-CM, we assessed acute complication rates for 3,289 surgically treated LDH patients and 4,025 nonoperative LDH patients, identifying complications from codiagnoses. The complication rates were significantly correlated with the postoperative length of stay and with the risk factors of obesity, hypertension, and diabetes. We found fewer instances of thrombophlebitis (0.3/1,000) and slightly lower mortality (0.9/1,000) than previously reported. Although the frequency of the cauda equina syndrome in the literature approximates our findings of 5/1,000, our data did not allow correction for the fraction of preexistent cauda equina syndromes. Our any-complication-rate is 3.7%. Even though LDH surgery is relatively safe, its complications should not be overlooked.