Endoscopic Percutaneous Discectomy does not Decrease Complications, Re-admission, or Length of Stay in 522 Patients

Presented at SMISS Annual Forum 2016
By Peter Passias MD
With Gregory Poorman , Preston Grieco , Daniel Erman , Michael Gerling ,

Disclosures: Peter Passias MD B; Medicrea. Gregory Poorman None, Preston Grieco None, Daniel Erman None, Michael Gerling None,

Langone Medical Center, New York, NY

Introduction

Diskectomy is the most common surgery to improve pain and neurological deficit in the lumbar spine. Percutaneous endoscopic techniques are a relatively new attempt to reduce post-operative morbidity, and has shown positive results so far. However, there are no larger series examining peri-operative clinical outcomes of percutaneous endoscopic diskectomy to
other diskectomy approaches. 

Aims/Objectives

Compare 30-day complication rates in endoscopic lumbar diskectomies (ENDO) against all translaminar lumbar diskectomies (TLD) in a large, national database. 

Methods

Patients undergoing ENDO (CPT code 63056; defining components: transpedicular approach, single segment, lumbar) were compared to those undergoing TLD (CPT code 63030; defining components: any approach, single segment, lumbar) using the National Surgical Quality Improvement Program (years 2005-13); a retrospective review of a prospectively collected database. Fusion cases were excluded, as were certain major comorbidities (renal failure, ascities, dialysis, disseminated cancer, preop infected wound), and those under age 18. Chi-squared and Independent Samples t-tests compared primary outcome measures: 30-day complication rates, 30-day readmission, and hospital length of stay. Regression analysis was performed controlling for age, sex, ASA class, and BMI.

Results

522 ENDO and 13,187 TLD patients (average age 51.3, gender, 44.9% female) met inclusion criteria. ENDO patients were older (ENDO: 58.3 years vs. ELD: 51.0 years, p<0.001). Endoscopic procedures were on average 15 minutes longer (p<0.001). However, length of hospital stay (ENDO: 1.50 days vs. TLD: 1.61 days) and 30-day readmission (END: 3.1% vs. TLD: 3.3%, p=0.249) were statistically not significant. There was no significant difference in overall complication rate between the two cohorts (ENDO: 3.45% vs. TLD: 4.28%, p<0.436) including infection (ENDO: 2.11% vs. TLD: 2.34%, p=0.751), wound (ENDO: 0% vs. TLD: 0.167%, p=0.350), and peripheral nerve injury (ENDO: 0% vs. TLD: 0.053%, p=0.599) rates. Multivariate regression analysis, controlling for confounding factors, did not change these results (Any complication: OR: 0.8 [95% CI: 0.5-1.4]). 

Conclusions

In a study of 13,709 patients with 30 day followup, transpedicular endoscopic approach did not significantly decrease incidence of complications for lumbar diskectomy patients. Similarly, there was no discernible difference in length of hospital stay or 30-day readmission. This disagrees with previous studies.