Propensity-matched comparability of outcomes and value after macroscopic and microscopic lumbar discectomy utilizing a nationwide longitudinal database.
Neurosurg Focus. 2018 Could;44(5):E12
Authors: Pendharkar AV, Rezaii PG, Ho AL, Sussman ES, Purger DA, Veeravagu A, Ratliff JK, Desai AM
OBJECTIVE There was appreciable debate concerning the utility of the working microscope in lumbar discectomy and its impact on outcomes and value. METHODS A commercially out there longitudinal database was used to determine sufferers present process discectomy with or with out use of a microscope between 2007 and 2015. Propensity matching was carried out to normalize variations between demographics and comorbidities within the 2 cohorts. Outcomes, issues, and value have been subsequently analyzed utilizing bivariate evaluation. RESULTS A complete of 42,025 sufferers have been recognized for the “macroscopic” group, whereas 11,172 sufferers have been recognized for the “microscopic” group. For the propensity-matched evaluation, the 11,172 sufferers within the microscopic discectomy group have been in contrast with a bunch of 22,340 matched sufferers who underwent macroscopic discectomy. There have been no vital variations in postoperative issues between the teams apart from a better proportion of deep vein thrombosis (DVT) within the macroscopic discectomy cohort versus the microscopic discectomy group (zero.four% vs zero.2%, matched OR zero.48 [95% CI 0.26-0.82], p = zero.0045). Size of keep was considerably longer within the macroscopic group in comparison with the microscopic group (imply 2.13 vs 1.83 days, p < zero.0001). Macroscopic discectomy sufferers had a better price of revision surgical procedure when in comparison with microscopic discectomy sufferers (OR zero.92 [95% CI 0.84-1.00], p = zero.0366). Hospital fees have been larger within the macroscopic discectomy group (imply $19,490 vs $14,921, p < zero.0001). CONCLUSIONS The current research means that using the working microscope in lumbar discectomy is related to decreased size of keep, decrease DVT price, decrease reoperation price, and decreased general hospital prices.
PMID: 29712527 [PubMed – in process]