Incidental durotomy should not preclude same-day discharge from lumbar spine surgery

IF 4.7 1区医学 Q1 CLINICAL NEUROLOGY Spine Journal Pub Date : 2025-08-01 Epub Date: 2025-02-16 DOI:10.1016/j.spinee.2025.02.001

Austin C. Kaidi MD, MSc, Adin Ehrlich BA, Tarek Harhash BS, Tejas Subramanian BE, Kasra Araghi BS, Prerana Katiyar MD, Farah Musharbash MD, Eric Zhao BS, Sereen Halayqeh MD, Tomoyuki Asada MD, PhD, Andrea Pezzi MD, Atahan Durbas MD, Adrian Lui MD, Oliva Tuma BS, Rujvee Patel MD, James E. Dowdell MD, Sheeraz A. Qureshi MD, MBA, Sravisht Iyer MD

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Abstract

BACKGROUND CONTEXT

An incidental durotomy is a common surgical complication that can occur during any spine surgery. Although rarely associated with sequelae requiring intervention, keeping patients who sustained durotomy for overnight observation is a common clinical practice.

PURPOSE

To determine whether patients who sustained incidental durotomy during lumbar spine surgery can be safely discharged on the day of surgery.

DESIGN

Retrospective cohort study.

PATIENT SAMPLE

Patients who sustained incidental durotomy during elective lumbar microdiscectomy or decompression.

OUTCOME MEASURES

Outcome measures included complication rates, reoperation rates, readmission rates, patient reported outcome measures (PROMs) and return to activity metrics.

METHODS

Over a 7-year study period, 66 patients who sustained an incidental durotomy during elective primary microdiscectomy or decompression were identified. Patients were stratified by their discharge date on either postoperative day (POD) 0 (ambulatory) or POD1-14 (inpatient). A 2-tailed students t-test was utilized to determine if there was a difference in complication rates, PROMs, or return to activity metrics.

RESULTS

Among 66 patients who were identified, 18 were discharged on POD0 and 48 were discharged on POD1-14. Among these patients, only 27 (41%) had the durotomy repaired via primary suture repair. The vast majority utilized a combination of a dural patch and dural sealant. Overall, no significant differences were seen in complication rates, reoperation rates, readmission rates, PROMs, or return to activity metrics between the inpatient and ambulatory groups. For patients that required additional interventions for management of the durotomy, none presented within 48 hours of surgery.

CONCLUSION

Patients who sustain incidental durotomy during lumbar decompression/microdiscectomy can be safely discharge on the day of surgery if a watertight seal can be obtained via any repair method.

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意外硬膜切开不应排除腰椎手术当日出院。

背景背景：意外硬膜切开术是任何脊柱手术中都可能发生的常见手术并发症。虽然很少与需要干预的后遗症相关，但将进行硬膜切除术的患者留院观察过夜是一种常见的临床做法。目的：探讨腰椎手术中偶发硬膜切开患者能否在手术当日安全出院。设计：回顾性队列研究患者样本：在择期腰椎微椎间盘切除术或减压期间进行意外硬膜切开的患者。结果测量：结果测量包括并发症发生率、再手术率、再入院率、患者报告的结果测量（PROMs）和恢复活动指标。方法：在7年的研究期间，66例患者在择期原发性微椎间盘切除术或减压期间进行了意外硬膜切开术。根据出院日期对患者进行分层，分别为术后第0天（门诊）或第1-14天（住院）。采用双尾学生t检验来确定并发症发生率、prom或恢复活动指标是否存在差异。结果：66例确诊患者中，18例于POD0出院，48例于POD1-14出院。在这些患者中，只有27例（41%）采用一期缝线修复硬膜切开术。绝大多数使用硬脑膜贴片和硬脑膜密封剂的组合。总的来说，住院组和门诊组在并发症发生率、再手术率、再入院率、PROMs或恢复活动指标方面没有显著差异。对于需要额外干预来处理硬膜切开术的患者，没有人在手术48小时内出现。结论：在腰椎减压/微椎间盘切除术过程中，如果采用任何修复方法均能获得水密密封，则意外硬膜切开术患者可在手术当日安全出院。

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.