Durotomy During Outpatient Lumbar Discectomy Should Not Preclude Same-Day Discharge: A Case Series.

Abstract

Background and objectives: With advances in surgical techniques over the past 40 years, single-level lumbar hemilaminectomy and microdiscectomy (HLMD) has become a standard outpatient surgery. Incidental durotomy is a common complication of lumbar decompression surgeries and often precludes same-day discharge based on preexisting paradigms, involving bedrest that have no empirical support, but often lead to increased complications in available evidence-based studies. Limited data exist regarding the safety of same-day discharge after lumbar decompression involving an incidental durotomy. The objective of this study was to establish the safety of same-day discharge after repair of incidental durotomy after single-level lumbar HLMD.

Methods: This study involved a retrospective review of the electronic medical record for all adult patients undergoing single-level lumbar hemilaminectomy and microdiscectomy by a single surgeon at our institution from 2013 through 2021. Descriptive statistics were used for data analysis.

Results: 346 lumbar single-level HLMD were performed during this time frame by a single surgeon. There were 17 incidental durotomies (4.9%), all primarily repaired. Of the 17 patients with incidental durotomy, all but 5 returned home on postoperative day 0, with the 5 who remained inpatient staying for reasons unrelated to the dural tear. Patients had no durotomy-associated complications, readmissions, or reoperations regardless of same-day discharge home.

Conclusion: Same-day discharge after primary repair of incidental durotomy in single-level lumbar HLMD seems to be safe and may significantly improve health care costs associated with HLMD. This investigation should be expanded to other one-level to two-level lumbar decompression surgeries and minimally invasive and endoscopic approaches.