Outpatient Lumbar Microdiscectomy in France: From an Economic Imperative to a Clinical Standard—An Observational Study of 201 Cases

• Published in: World neurosurgery Vol. 106; pp. 891 - 897
• Main Authors: Debono, Bertrand, Sabatier, Pascal, Garnault, Valérie, Hamel, Olivier, Bousquet, Philippe, Lescure, Jean-Paul, Plas, Jean-Yves
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017
• Subjects: Adult; Aged; Ambulatory; Ambulatory Surgical Procedures - economics; Ambulatory Surgical Procedures - standards; Diskectomy - economics; Diskectomy - standards; Fast-tracking; Female; Follow-Up Studies; France - epidemiology; Humans; Intervertebral Disc Displacement - economics; Intervertebral Disc Displacement - epidemiology; Intervertebral Disc Displacement - surgery; Lumbar discectomy; Male; Microsurgery - economics; Microsurgery - standards; Middle Aged; Outpatient; Patient Satisfaction - economics; Treatment Outcome; Young Adult; Fast-tracking; LOS; ADL; VAS; Ambulatory; Outpatient; Lumbar discectomy; FT; ERAS
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.07.065

The outpatient lumbar discectomy procedures have been established for more than 2 decades. However, especially in Europe, there are still obstacles to the development of these procedures, which may be related to medicoeconomic imperatives, and to several factors concerning both surgeons and patients. We describe our initial experience in introducing this method in our institution.
During a 3-year period, 201 patients met the criteria for ambulatory lumbar microdiscectomy. A dedicated fast-tracking unit provided preoperative patient education and immediate postoperative follow-up. A surgical consultation was organized 6 weeks after surgery, and a late satisfaction phone survey concerning ambulatory management was carried out after 6 months.
The average total inpatient time was 10 hours and 12 minutes. One patient (0.5%) remained overnight because of an anxiety attack. No patients contacted the FT unit during the first night, and no complications occurred. All patients were reviewed in consultation around day 45: the average visual analog scale score was significantly reduced. At this early postoperative follow-up, 87.5% of patients were (very) satisfied with this procedure. At the day 180 survey, average visual analog scale scores were not significantly different from the day 45 data. In terms of return to normal activities of daily living, 120 patients (60%) had no limitation, 72 patients (36%) had minor or major limitations, and 8 (4%) were incapacitated. At this final evaluation, 8% of patients (n = 16) were very satisfied, 73% were satisfied (n = 146), 11% (n = 22) were partly satisfied, and 8% (n = 16) were not satisfied with the outpatient procedure.
Reducing hospitalization for lumbar discectomies to a few hours is not a reduction in the quality of care. It is not necessarily simple to overcome the resistances of all protagonists, but placing the patient as the main actor of an integrated management plan is the key to transforming a medicoeconomic incentive into a clinical success.