Lauren M Boden, Susanne H Boden, Najib Muhammad, Matthew A Kanzler, David S Casper
{"title":"Complications and Cost in Open Versus Endoscopic Lumbar Decompression: A Database Study.","authors":"Lauren M Boden, Susanne H Boden, Najib Muhammad, Matthew A Kanzler, David S Casper","doi":"10.1097/BSD.0000000000001745","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>A retrospective database study.</p><p><strong>Objective: </strong>To compare complications and costs associated with endoscopic and open lumbar decompression on a large scale.</p><p><strong>Background: </strong>Though open lumbar decompression is considered the gold standard, endoscopic procedures are on the rise. The majority of studies comparing endoscopic to open decompression have been limited to small retrospective studies or studies in other countries.</p><p><strong>Methods: </strong>Patients who underwent single-level endoscopic or open lumbar decompression from 2017 to 2021 with a 2-year follow-up were identified in the PearlDiver database using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. Multilevel surgery, concomitant fusion, or cervical/thoracic procedures were excluded. Postoperative complications, including infection, wound dehiscence, and dural tear, were evaluated for both groups, as well as additional lumbar surgery within 2 years. Costs, complications, and rate of repeat surgery were compared between groups.</p><p><strong>Results: </strong>A total of 895 endoscopic and 102,258 open lumbar decompression cases met the inclusion criteria. The median age range was 60-64 for both groups, and the majority were low risk on the Charlson Comorbidity Index. Rates of dural tear, infection, and dehiscence were similar between groups. Total cost at 2 years was slightly higher for the endoscopic group ($20,347 vs $18,089, P = 0.03). Patients who underwent endoscopic lumbar decompression were more than twice as likely to undergo a second lumbar surgery in the following 2 years (16% vs 7%, P < 0.00001). Of the patients who underwent additional surgery, there was a higher proportion of patients undergoing reexploration in the open group (33.4% vs 13.8%, P < 0.00001) and a higher proportion undergoing endoscopic decompression in the endoscopic group (35.5% vs 0.64%, P < 0.00001).</p><p><strong>Conclusions: </strong>Cost and complication profiles are similar between endoscopic and open lumbar decompression. However, endoscopic decompression patients are more than twice as likely to undergo a second procedure within 2 years. Prospective studies are needed to determine the cause of additional surgery.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":"38 7","pages":"E383-E387"},"PeriodicalIF":1.7000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001745","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/6 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Study design: A retrospective database study.
Objective: To compare complications and costs associated with endoscopic and open lumbar decompression on a large scale.
Background: Though open lumbar decompression is considered the gold standard, endoscopic procedures are on the rise. The majority of studies comparing endoscopic to open decompression have been limited to small retrospective studies or studies in other countries.
Methods: Patients who underwent single-level endoscopic or open lumbar decompression from 2017 to 2021 with a 2-year follow-up were identified in the PearlDiver database using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes. Multilevel surgery, concomitant fusion, or cervical/thoracic procedures were excluded. Postoperative complications, including infection, wound dehiscence, and dural tear, were evaluated for both groups, as well as additional lumbar surgery within 2 years. Costs, complications, and rate of repeat surgery were compared between groups.
Results: A total of 895 endoscopic and 102,258 open lumbar decompression cases met the inclusion criteria. The median age range was 60-64 for both groups, and the majority were low risk on the Charlson Comorbidity Index. Rates of dural tear, infection, and dehiscence were similar between groups. Total cost at 2 years was slightly higher for the endoscopic group ($20,347 vs $18,089, P = 0.03). Patients who underwent endoscopic lumbar decompression were more than twice as likely to undergo a second lumbar surgery in the following 2 years (16% vs 7%, P < 0.00001). Of the patients who underwent additional surgery, there was a higher proportion of patients undergoing reexploration in the open group (33.4% vs 13.8%, P < 0.00001) and a higher proportion undergoing endoscopic decompression in the endoscopic group (35.5% vs 0.64%, P < 0.00001).
Conclusions: Cost and complication profiles are similar between endoscopic and open lumbar decompression. However, endoscopic decompression patients are more than twice as likely to undergo a second procedure within 2 years. Prospective studies are needed to determine the cause of additional surgery.
研究设计：回顾性数据库研究。目的：比较内镜下腰椎减压术和开放式腰椎减压术的并发症和费用。背景：虽然开放式腰椎减压术被认为是金标准，但内窥镜手术正在增加。大多数比较内窥镜减压和开放减压的研究仅限于小型回顾性研究或其他国家的研究。方法：2017年至2021年接受单节段内窥镜或开放式腰椎减压术的患者，随访2年，使用现行程序术语和国际疾病分类第十版代码在PearlDiver数据库中进行识别。排除了多节段手术、合并融合或颈椎/胸椎手术。评估两组患者的术后并发症，包括感染、伤口裂开和硬脑膜撕裂，以及2年内额外的腰椎手术。比较两组间的费用、并发症和重复手术率。结果：895例内镜下腰椎减压术和102258例开放式腰椎减压术符合纳入标准。两组患者的中位年龄范围为60-64岁，大多数患者的Charlson合并症指数风险较低。两组间硬脑膜撕裂、感染和破裂的发生率相似。内镜组2年的总成本略高（20,347美元vs 18,089美元，P = 0.03）。接受内窥镜腰椎减压术的患者在接下来的2年内接受第二次腰椎手术的可能性是前者的两倍多（16% vs 7%, P < 0.00001）。在接受额外手术的患者中，开放组患者再次探查的比例更高（33.4% vs 13.8%, P < 0.00001），内镜组患者进行内镜减压的比例更高（35.5% vs 0.64%, P < 0.00001）。结论：内镜下腰椎减压术和开放式腰椎减压术的成本和并发症相似。然而，内窥镜减压患者在2年内接受第二次手术的可能性是其两倍多。需要前瞻性研究来确定额外手术的原因。
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
