Care close to home - a retrospective analysis of patients undergoing elective lumbar surgery in a rural satellite hospital

• Published in: Canadian Journal of Surgery 2022-12, Vol.65, p.S145-S146
• Main Authors: Kennedy, Colton, Puskas, David, Pahuta, Mark, Marion, Travis
• Format: Article
• Language: English
• Subjects: Back surgery; Body mass index; Patients; Rural areas
• ISSN: 0008-428X; 1488-2310

Background: Patients from rural communities face multiple barriers in accessing operative care. Given the recent reduced access to the operating room in tertiary centres, alternative strategies are necessary to provide patients with the care they need. In March 2021 our region expanded elective operative interventions into a satellite centre to be performed by the tertiary surgical team. Patients from rural communities and those willing to travel were carefully selected. The primary objective was to report the incidence of adverse events in patients undergoing elective lumbar surgery at this centre. Secondary objectives were to assess length of stay, readmissions and wait times. Methods: Patients who underwent elective lumbar spine surgery in satellite centres were identified through surgeon billings. All patients were monitored perioperatively by a nurse practitioner-led virtual platform. This collected demographic data such as age, sex, body mass index (BMI) and smoking status. It also prospectively collected patient-reported outcome measures, and adverse events up to 30 days. Adverse events were additionally retrospectively collected from patient records. Results: Twenty-one patients have received surgery to date; the average age was 54 years (standard deviation [SD] 11.84 yr). Average BMI and American Society of Anesthesiologists (ASA) were 2 7.4, and 2.14 respectively. Thirteen patients underwent at least a single-level fusion. Average operative time was 74.9 minutes (SD 27.6 min). All simple decompressions were performed as outpatients, and patients who underwent fusions were discharged on postoperative day 1. Six patients (28%) experienced at least 1 adverse event. All were considered minor, with the exception of 1 delayed presentation dural tear requiring revision surgery, and 1 postoperative reduction of muscle strength in dorsiflexion that has since improved. No transfusions, cardiopulmonary events, emergency transfers or deaths occurred. Average wait time to surgery was only 86.1 days. Conclusion: Elective lumbar spine surgery performed in rural satellite centres on selected patients by an experienced surgical team has a low rate of adverse events. It allows rural patients to have surgery close to home, and it has an average time to surgery of less than 3 months. This has the potential to improve access to surgical care and reduce cost of delivery in a safe manner.