Can the Full-Percutaneous Endoscopic Lumbar Discectomy in Day Surgery Mode Achieve Better Outcomes Following Enhanced Recovery after Surgery Protocol? A Retrospective Comparative Study

Le Kou; Wentao Wan; Chao Chen; Dong Zhao; Xun Sun; Ziwei Gao; Hongjin Wu; Mingyuan Di; Xinlong Ma; Baoshan Xu; Jun Miao; Zheng Wang; Qiang Yang

doi:10.3389/fsurg.2022.914986

Can the Full-Percutaneous Endoscopic Lumbar Discectomy in Day Surgery Mode Achieve Better Outcomes Following Enhanced Recovery after Surgery Protocol? A Retrospective Comparative Study

Front Surg. 2022 May 20:9:914986. doi: 10.3389/fsurg.2022.914986. eCollection 2022.

Authors

Le Kou^{1

2}, Wentao Wan³, Chao Chen¹, Dong Zhao¹, Xun Sun¹, Ziwei Gao^{1

3}, Hongjin Wu³, Mingyuan Di³, Xinlong Ma¹, Baoshan Xu¹, Jun Miao¹, Zheng Wang⁴, Qiang Yang¹

Affiliations

¹ Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
² Department of Orthopedics, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China.
³ Graduate School, Tianjin Medical University, Tianjin, China.
⁴ Department of Orthopedics, No.1 Medical Center of Chinese PLA General Hospital, Beijing, China.

Abstract

Background: Full-percutaneous endoscopic lumbar discectomy (F-PELD) is a popular operation for the treatment of lumbar disc herniation (LDH). Some studies have reported that F-PELD in day surgery mode produced favorable outcomes for LDH. At the same time, minimally invasive spinal surgery following enhanced recovery after surgery (ERAS) presents a rising trend in recent years, but few studies reported whether F-PELD will produce better outcomes in the day surgery (DS) mode combined with ERAS.

Objective: To analyze whether F-PELD in day surgery mode following ERAS can produce better clinical outcomes than in traditional surgery mode.

Methods: The patients who underwent F-PELD between January 2019 and October 2020 were retrospectively analyzed, and the patients who met the inclusive criteria were followed up. The patients were divided into day surgery (DS) group (n = 152) that combined with ERAS and traditional surgery (TS) group (n = 123) without ERAS. The length of hospital stays (LOS), visual analogue scale (VAS), and Oswestry Disability Index (ODI) of two groups were compared before surgery, immediately after surgery, one month after surgery, and one year after surgery.

Results: A total of 298 patients who underwent F-PELD were reviewed. 290 patients were included in the study and followed up, and 275 patients who had completed the follow-up were available for analysis. There were no statistically significant differences between the two groups in terms of age, gender, preoperative VAS, and ODI. There were significant statistical differences in the VAS and ODI immediately after surgery (VAS for back pain: DS group 1.4 ± 1.1, TS group 2.0 ± 1.2, p < 0.001; VAS for leg pain: DS group 0.8 ± 0.8, TS group 1.1 ± 1.1, p = 0.010; ODI: DS group 5.8 ± 4.3, TS group 7.6 ± 7.4, p = 0.010) and one month after surgery (VAS for back pain: DS group 0.8 ± 0.9, TS group 1.1 ± 1.0, p = 0.035; ODI: DS group 3.2 ± 3.5, TS group 4.5 ± 6.5, p = 0.036). At one year after surgery, the VAS (back pain: DS group 0.3 ± 0.6, TS group 0.3 ± 0.7, p = 0.798; leg pain: DS group 0.2 ± 0.4, TS group 0.1 ± 0.4, p = 0.485) and ODI (DS group 0.8 ± 1.2, TS group 0.7 ± 1.7, p = 0.729) were further improved, but no statistically significant difference was observed between two groups. LOS of DS group (1.38 ± 0.49 days) was significantly shorter than the TS group (5.83 ± 2.24 days, p < 0.001), and some postoperative complications occurred in the TS group, including throat discomfort (n = 5, 4.1%), discomfort after catheterization (n = 7, 5.7%), abdominal distention (n = 3, 2.4%), and nausea (n = 5, 4.1%). None of the above complications resulted in serious consequences.

Conclusion: The F-PELD in day surgery mode following ERAS produced a better short-term clinical effect and reduced the LOS, which is worthy of promotion.

Keywords: day surgery; endoscopy; enhanced recovery after surgery; lumbar disc herniation; percutaneous endoscopic lumbar discectomy.

Grants and funding

This study was supported by National Key R&D Program of China (2020YFC1107402), National Natural Science Foundation of China (81871782), Tianjin Science Fund for Distinguished Young Scholars (18JCJQJC47900), Medical Innovation Fund for Clinical Application of National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (2021-NCRC-CXJJ-ZH-22).