Length of stay, costs, and complications in lumbar disc herniation surgery by standard PLIF versus a new dynamic interspinous stabilization technique

• Published in: Patient safety in surgery 2017-11, Vol.11 (1), p.26-26, Article 26
• Main Authors: Segura-Trepichio, Manuel, Candela-Zaplana, David, Montoza-Nuñez, José Manuel, Martin-Benlloch, Antonio, Nolasco, Andreu
• Format: Article
• Language: English
• Subjects: Analysis; Complications and side effects; Discectomy; Health aspects; In-hospital costs; Length of stay; Lumbar disc herniation; Lumbar fusion; Medical care, Cost of; Safety and security measures; Surgery; Surgical safety; Urinary tract infections
• ISSN: 1754-9493; 1754-9493
• DOI: 10.1186/s13037-017-0141-1

The number of lumbar spine surgeries has been increasing during the last 20 years, which also leads to an increase in hospital costs and complications related to surgery. Therefore, there is a greater concern about the costs and safety of the techniques and implants used. Patients (aged from 18 to 50 years) presenting with lumbago /sciatica (ICD-10-CM M54.3, M54.4) due to lumbar disc herniation lasting more than 12 weeks, were included. Patients with disc herniation larger than size-2 or size-3 according to the MSU Classification were eligible for participation. Intervention was divided in two groups. In Group 1, patients underwent microdiscectomy and Interspinous Dynamic Stabilization System (IDSS). Meanwhile, in Group 2, patients received discectomy and posterior lumbar interbody fusion (PLIF). The primary outcome measure was the length of stay and costs during hospital admission. We also evaluated several other outcome parameters, including 90- day readmission rate, 90-day complication rate, and re-operations rate. The study was an observational prospective cohort study carried out from January 2015 to August 2016 in which two surgical techniques were compared. Our hypothesis was that a less aggressive procedure, such as discectomy and DSS, will decrease the length of stay and costs, and that it will also reduce the rate of complications with respect to PLIF. A total of 67 patients (mean age 39.8 ± 8.4 years) were included. Patients in the PLIF group had a length of stay increase of 109% (4.52 ± 1.76 days vs 2.16 ± 1.18 days   0.999) and 90-day complication rates (35.5% vs 52.8% €  > 0.156). Dural tear and urinary tract infection rates were higher in the PLIF cohort (13.9% vs 3.2%.  = 0.205 and 11.1% vs 0%  = 0.118, respectively). Implant related complications were the most frequent in both IDSS and PLIF groups (32.3% vs 38.9%  = 0.572). Patients who underwent IDSS had a significant decrease of the length of stay and costs in relation to PLIF group. No significant differences were found in 90-day readmission and reintervention rates for both groups. Although