30-Day Recurrence, Readmission Rate, and Clinical Outcome After Emergency Lumbar Discectomy.

Autor:	Reito A; Department of Orthopedics and Traumatology, Central Finland Hospital, Jyväskylä, Finland.; Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland., Kyrölä K; Department of Orthopedics and Traumatology, Central Finland Hospital, Jyväskylä, Finland., Pekkanen L; Department of Orthopedics and Traumatology, Central Finland Hospital, Jyväskylä, Finland., Paloneva J; Department of Orthopedics and Traumatology, Central Finland Hospital, Jyväskylä, Finland.; School of Medicine, University of Eastern Finland, Kuopio, Finland.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2020 Sep 15; Vol. 45 (18), pp. 1253-1259.
DOI:	10.1097/BRS.0000000000003519
Abstrakt:	Study Design: A retrospective cohort study. Objective: To investigate the 30-day recurrence rate after emergency lumbar discectomy. Secondary aims were to investigate the factors affecting the 30-day recurrence and readmission rates and clinical outcome. Summary of Background Data: Excluding cauda equine syndrome (CES) due to massive intervertebral disc herniation, emergency surgery for lumbar disc herniation (LDH) is rarely required. The operation may, however, be performed for other reasons such as persistent or progressive motor paresis associated with radiculopathy or uncontrolled pain. Literature on these topics is scarce. Methods: All patients admitted for inpatient care after a visit to the emergency department (ED) due to acute low back pain and who had subsequently undergone an emergency lumbar discectomy during the 4-year study period were included in the study. Patients attending the ED who subsequently had a delayed discectomy formed the control group. Recurrence and readmission rates were analyzed and clinical outcome at 30 days post-surgery was assessed with the Oswestry Disability Index (ODI) and the visual analog pain scale (VAS). Results: One hundred thirty patients were admitted to the hospital after visiting the ED and underwent an emergency discectomy after a median of 1.0 days from admittance. Six patients in the study group [4.6% (95% CI: 2.1-9.7)] had recurrent LDH and nine patients in total [6.9% (95% CI: 3.9-12.6)] were readmitted within 30 days. None of the baseline variables clearly predicted recurrence. Mean ODI difference between the study group and controls was 8.1 (95% CI: -6.7-23.2). BMI and surgery by a non-spine surgeon were associated with higher ODI values. Conclusion: An emergency discectomy is associated with a higher rate than expected of both recurrent LDHs and 30-day readmissions. Surgeon experience and patient-related factors had minor effects on the 30-day clinical outcome. Level of Evidence: 4.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu