gms | German Medical Science

68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
7. Joint Meeting mit der Britischen Gesellschaft für Neurochirurgie (SBNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

14. - 17. Mai 2017, Magdeburg

Is there a difference in early readmission and delayed discharge after lumbar discectomy in subjects with or without a bone anchored anluar closure – German subanalysis from a multicenter, prospective, randomised study

Meeting Abstract

  • Richard Bostelmann - Neurochirurgische Klinik, Universitätsklinik Düsseldorf, Duesseldorf, Deutschland
  • Adisa Kuršumovic - DONAUISAR Klinikum Deggendorf, Deggendorf, Deutschland
  • Volkmar Heidecke - Klinikum Augsburg, Klinik für Neurochirurgie, Augsburg, Deutschland
  • S. Fröhlich - Orthopädie, Universitätsklinik, Rostock, Deutschland
  • Martin Berth - Knappschafts-Krankenhaus Bochum-Langendreer, Klinik für Neurochirurgie, Bochum, Deutschland
  • J. Perrin - Neurochirurgie, Universitätsklinik, Mannheim, Deutschland
  • Senol Jadik - Universitätsklinikum Schleswig-Holstein, Campus Kiel, Neurochirurgische Abteilung, Kiel, Deutschland
  • Peter Vajkoczy - Charité - Universitätsmedizin Berlin, Campus Mitte, Neurochirurgische Klinik, Berlin, Deutschland
  • E. von Saldern - Wirbelsäulen- und Neurochirurgie, Westklinikum Hamburg, Hamburg, Deutschland
  • Peter Douglas Köassen - St. Bonifatius Hospital gGmbH, Abteilung für Wirbelsäulenchirurgie und Neurotraumatologie , Neurochirurgische Abteilung, Lingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDi.01.06

doi: 10.3205/17dgnc182, urn:nbn:de:0183-17dgnc1820

Veröffentlicht: 9. Juni 2017

© 2017 Bostelmann et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Readmissions and reoperations within the first few months of surgery are major factors driving negative clinical and financial outcomes. Providers are increasingly being asked to bear the financial burden of hospital admissions that occur within a certain time period after the index surgery, typically 30-90 days. Reherniation and progressive degeneration with are the main causes of poor outcome after lumbar discectomy and may necessitate early readmission and reoperation. An anular closure device (ACD) has been developed to address these causes, and a multicenter, prospective, post-market randomized clinical trial (RCT) is ongoing. This report evaluates the early safety of discectomy augmented with a bone-anchored ACD (treatment group) compared with discectomy alone (control group) at German centers in terms of delayed discharge and hospital readmission within the first 30, 60 and 90 days after surgery.

Methods: The study population for this interim analysis consisted of all enrolled patients at German centers (10/21 sites) with 243/554 (115/278 control, 128/276 treatment) from an ongoing RCT to demonstrate superiority of discectomy with anular closure relative to discectomy alone. Key inclusion criteria include 6 weeks of failed conservative treatment, posterior disc height of ≥5mm, minimum defect width and height, and baseline Oswestry and visual analog scale leg pain scores ≥40/100. Key exclusion criteria include prior surgery at the index level. This report, which comports with the study statistical analysis plan, presents safety and early readmission results within the first 30, 60 and 90 days after surgery by examining serious adverse events that were reviewed by a data safety monitoring board..

Results: Implanted patients in the treatment group had significant lower incidences of readmissions or delayed discharges that were device or procedure related and index-level reoperations, compared with the control group.

Conclusion: Discectomy augmented with bone-anchored anular closure has a similar safety profile compared with discectomy alone, with similar adverse event rates and minimal device-related complications reported. Furthermore, anular closure was associated with substantially lower rates of reoperations and early readmissions or delayed discharges, compared to discectomy alone. These results suggest that bone-anchored anular closure could play an important role in reducing short-term clinical and financial burdens following lumbar discectomy.