Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery

Abstract INTRODUCTION Lumbar spine surgery can be successfully performed using various anesthetic techniques. Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia (SA) to general anesthesia (GA) in lumbar surgery. We sought to elucidate the more expedient anesthetic technique. METHODS Following IRB approval, a retrospective review of patients undergoing elective lumbar decompression surgery using GA or SA was performed. Demographic data known to influence perioperative morbidity was collected as well as safety and efficiency parameters. After controlling for patient and procedure characteristics, simple linear and multivariate regression analyses were performed to identify differences in operative blood loss, operative time, time from entering the OR until incision, time from bandage placement to exiting the OR, total anesthesia time, time in the post-anesthesia care unit (PACU), and length of hospital stay. RESULTS >544 consecutive lumbar laminectomy and discectomy surgeries were identified with 183 undergoing GA and 361 undergoing SA. The following times were all shorter for patients receiving SA than GA: operative time (97.4 vs. 151.8 min., P < 0.001), total anesthesia time (145.6 vs. 217.5 min., P < 0.001), time from entering the OR until incision (38.3 vs. 46.8 min., respectively, P < 0.001), time from bandage placement until exiting the OR (10.2 vs. 17.2 min., P < 0.001), and length of hospital stay (1.5 vs. 3.1 days, P < 0.001). The mean PACU length of stay was longer in the SA group than the GA group (178.0 vs. 116.5 min., P < 0.001). Estimated blood loss was less in the SA group than the GA group (62.1 vs. 176.3 mL, P < 0.001). CONCLUSION Spinal anesthesia may be the more expedient method of anesthesia in lumbar spinal surgery for all perioperative time points except for time in the PACU.

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Incidental Dural Tear in Lumbar Spine Surgery: A Prospective Study

International Journal of Orthopaedics Research ◽

10.33140/ijor.04.03.01 ◽

2021 ◽

Vol 4 (3) ◽

Keyword(s):

Lumbar Spine ◽

Hospital Stay ◽

Spine Surgery ◽

Length Of Hospital Stay ◽

Lumbar Spine Surgery ◽

Lumbosacral Spine ◽

Dural Tear ◽

Vas Score ◽

Significant Difference ◽

Dural Tears

Introduction: Incidental dual tear is a complication of spinal surgery characterized by an accidental nick of the spinal dural sheath during operative procedures. The worldwide incidence of dural tear according to previous literature varies widely (1- 17%) and in general depends on the type and complexity of the procedure. The present was carried to evaluate the incidence of dural tear in lumbar spine surgery, and to study clinical outcomes in terms of VAS score ODI score and length of hospital stay. Methods: This was a prospective, observational and case control study conducted on 40 patients who underwent elective Lumbosacral spine surgery. The incidence of dural tear was evaluated and the patients were divided into with dural tear and without dural tear. The clinical outcome such as visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score and length of hospital stay were evaluated. Results: The incidence of Dural tear in our study population was found to be 7.5%. The ODI score was significantly higher in dural tear as compared to without dual tear at various postoperative periods. Further, there was no significant difference in the VAS scores with and without dural tear patients. The length of hospital stay was significantly higher in patients with dural tear as compared to without dural tear (11.63±6.19 vs 3.06±1.02 days; p=0.004). Conclusion: Incidental Dural tears if detected and managed accordingly, adverse clinical and postoperative outcomes can be reduced effectively and also increases the quality of life in patients.

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