Clinical and health economic benefits of out-patient lumbar microdiscectomies in Australia

Abstract

Abstract 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.