Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

Area of Science:

• Neurosurgery
• Spinal Surgery
• Surgical Outcomes

Background:

• Lumbar microdiscectomy outcomes are similar for inpatient and day-case procedures.
• Day-case lumbar microdiscectomy is underutilized within the National Health Service (NHS).

Purpose of the Study:

• To identify key factors associated with successful same-day discharge for patients undergoing elective lumbar microdiscectomy.
• To inform strategies for increasing the utilization of day-case lumbar microdiscectomy.

Main Methods:

• Retrospective observational study of 95 patients undergoing elective lumbar microdiscectomy (August 2012 - December 2014).
• Logistic regression analysis was used to evaluate the influence of patient demographics, clinical factors, and surgical details on same-day discharge.
• Variables examined included age, gender, day of surgery, hospital distance, ASA grade, opiate use, smoking status, surgical list order, and surgical site/level.

Main Results:

• 29.5% of patients were discharged on the day of surgery.
• Univariate analysis showed age, ASA grade, hospital distance, and surgical list order were associated with same-day discharge.
• Multivariate analysis confirmed ASA grade, hospital distance, and morning surgery as significant predictors of same-day discharge.

Conclusions:

• Careful patient selection is crucial for successful day-case lumbar microdiscectomy.
• Younger, fitter patients residing closer to the hospital, and scheduled for morning surgery, have higher rates of same-day discharge.
• Optimizing elective surgical lists based on these factors can improve hospital bed utilization and enhance spinal service efficiency.