Safety and feasibility of same-day discharge following lumbar decompression surgery: A systematic review

• Published in: Brain & spine Vol. 2; p. 100888
• Main Authors: Goacher, Edward, Sanders, Matthew I., Ivanov, Marcel
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 2022; Elsevier
• Subjects: Complications; Day-case; Lumbar decompression; Outpatient; Outpatient; Lumbar decompression; Complications; Day-case
• ISSN: 2772-5294; 2772-5294
• DOI: 10.1016/j.bas.2022.100888

Lumbar decompression (LD) surgery, with or without discectomy, is a commonly performed surgical procedure. Despite the concept of day-case LD being reported as early as the 1980s, day-case LD is yet to become routine clinical practice. This systematic review aimed to examine the published literature on the safety and complication rates of day-case LD. Secondary outcome measures, including the economic impact and patient satisfaction of day-case LD, were also examined. A systematic electronic search was carried out on PubMed, EMBASE and the Cochrane Library between 1999 and January 2022. Studies were screened against predefined inclusion/exclusion criteria with the quality of included studies subsequently being assessed. In total, 15 studies were included in this review. The majority of studies were undertaken in the USA (n ​= ​8, 53%) and were of a case series design (n ​= ​9, 60%). Reported complication rates ranged from 0% to 7.8%, with nine studies reporting a complication rate of <4%. Readmission rates ranged from 0% to 7.7%. Seven studies quoted a readmission rate of 0%. Five studies found cost saving benefits of day-case LD in comparison to inpatient LD of up to $27,984 (USD). Patient acceptability of day-case LD was consistently high across the six studies that assessed it. Day-case LD surgery is a safe and economically efficient surgical option in appropriately selected patients. •Complication and readmission rates amongst patients undergoing day-case lumbar decompression surgery are low.•Patient acceptability of day case lumbar decompression surgery is high.•Day case lumbar decompression surgery is associated with significant cost savings.•Obstacles to day case lumbar decompression surgery include patient, primary care and ward factors.