Article
Comparison of incidence of adverse events in microsurgical lumbar discectomy in elective versus emergency setting
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Authors
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M. Hlavac
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
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K. Kiening
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
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R. Wirtz
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
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D. Haux
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
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A. Unterberg
- Neurochirurgische Klinik, Universitätsklinikum Heidelberg
| Published: | May 20, 2009 |
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Outline
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Objective: In patients with lumbar disc herniation and pronounced neurological deficit rapid decompression of the nerve root is indicated. In the daily routine of many neurosurgical departments this is often performed at night. Critics of this practice often point out a supposed worse outcome of such operations.
The aim of our study was to compare the incidence of adverse events in microsurgical discectomy for lumbar disc herniation in the elective versus an emergency setting.
Methods: In our department we record perioperative adverse events in a prospective manner using a computer-based database system. Data collection is performed in a fortnightly staff meeting reviewing outcome and adverse events of every operation performed. We compare the incidence of adverse events recorded in our database for microsurgical discectomy performed during regular working hours (8–17h, n=525) to those performed during call hours (17-8h, n=58). All datasets for lumbar microsurgical discectomy performed between January 2006 and August 2008 were analyzed for the presence of surgical site infection, CSF-leak, hematoma and recurrent disc herniation within 90 days.
Results: The overall rate of adverse events was 7.0% in the elective group versus 8.6% in the emergency group. They consist of 0.57% versus 0.0% for infection, 0.76% versus 0.0% for CSF-leak, 0.19% versus 0.0% for hematoma, 3.43% versus 5.17% for recurrent herniation, and 2.10% versus 3.45% for other adverse events in the elective and emergency group respectively. Even though the rates of overall adverse events and recurrent herniation are lower in the elective group, neither difference reached statistical significance in the χ-square test with p=0.66 for all adverse events combined and p=0.50 for recurrent herniation.
Conclusions: Assuming a worse medical condition of patients undergoing emergency microsurgical discectomy for lumbar disc herniation and a supposedly suboptimal working environment during night time we do not see any significant difference in the incidence of adverse events in elective and emergency operations. Given proper indication, based on our prospectively collected data it is safe to perform these operations at the earliest time possible.
