Clinical and health economic benefits of out-patient lumbar microdiscectomies in Australia
Publicado en línea: 25 ene 2018
Páginas: 15 - 20
DOI: https://doi.org/10.21307/ajon-2017-129
Palabras clave
© 2016 Alison Magee et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Introduction
This study reports on the clinical, nursing and health outcomes on the out-patient lumbar microdiscectomy program at a single institution. A multi-disciplinary team approach to the pre- and post-operative planning and education is key to the success of this program.
Methods
A retrospective review of prospectively collected data for two patient groups (out-patient microdiscectomy and in-patient microdiscectomy) over a two-year period in a single institution was performed. Clinical, demographical, surgical and economic measures were collected including a 10-point visual analogue pain scale (VAS), patient satisfaction, direct and indirect costs of treatment. Patients included had a single level lumbar disc prolapse with persistent disabling sciatica of more than 8 weeks consistent with failure of conservative measures.
Results
Twenty-one out-patient and forty-one in-patient microdiscectomy patients were treated over this period. Post operatively pain levels showed a significant improvement in VAS levels from 5.2 ±2.9 to 1.6 ±0.8 and 0.7 ± 0.8 at day 1 and 7 post-operatively respectively. This was not different across both groups. Patient satisfaction was high in both surgical groups. There was a significant cost savings in out-patient lumbar micro-discectomy with the majority of savings coming from costs associated with staff (nursing, allied health and medical) funding. There was successful discharge 100% of out-patient microdiscectomy patients without readmission.
Conclusion
Outpatient lumbar microdiscectomy is a viable option in Australia. It demonstrates no difference in patient outcomes as compared to in-patient lumbar microdiscectomies and has high patient satisfaction outcomes. There are significant benefits in terms of health economics and nursing care in establishing an out-patient lumbar microdiscetomy program.