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      Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation

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          Abstract

          Aims

          The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events.

          Patients and Methods

          This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression.

          Results

          Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity.

          Conclusion

          The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470–477.

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          Most cited references17

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          Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

          To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Randomised controlled trial. Nine Dutch hospitals. 283 patients with 6-12 weeks of sciatica. Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed. Scores from Roland disability questionnaire for sciatica, visual analogue scale for leg pain, and Likert self rating scale of global perceived recovery. Of the 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiscectomy. Of the 142 patients assigned to conservative treatment, 62 (44%) eventually required surgery, seven doing so in the second year of follow-up. There was no significant overall difference between treatment arms in disability scores during the first two years (P=0.25). Improvement in leg pain was faster for patients randomised to early surgery, with a significant difference between "areas under the curves" over two years (P=0.05). This short term benefit of early surgery was no longer significant by six months and continued to narrow between six months and 24 months. Patient satisfaction decreased slightly between one and two years for both groups. At two years 20% of all patients reported an unsatisfactory outcome. Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year and these did not change during the second year. ISRCT No 26872154.
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            Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure.

            We examined the rates of postoperative complications and mortality, as recorded in a hospital discharge registry for the State of Washington for the years 1986 through 1988, for patients who had had an operation on the lumbar spine. When patients who had had a malignant lesion, infection, or fracture are excluded, there were 18,122 hospitalizations for procedures on the lumbar spine, 84 per cent of which involved a herniated disc or spinal stenosis. The rates of morbidity and mortality during hospitalization, as well as the hospital charges, increased with the ages of the patients. The rate of complications was 18 per cent for patients who were seventy-five years or older. Nearly 7 per cent of patients who were seventy-five years old or more were discharged to nursing homes. Complications were most frequent among patients who had spinal stenosis, but multivariate analysis suggested that the complications associated with procedures for this condition were primarily related to the patient's age and the type of procedure. Complications, length of hospitalization, and charges were higher for patients who had had a spinal arthrodesis than for those who had not. Over-all, operations for conditions other than a herniated disc were associated with more complications and greater use of resources, particularly when arthrodesis was performed, than were operations for removal of a herniated disc. No data on symptoms or functional results were available.
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              Use of administrative medical databases in population-based research.

              Administrative medical databases are massive repositories of data collected in healthcare for various purposes. Such databases are maintained in hospitals, health maintenance organisations and health insurance organisations. Administrative databases may contain medical claims for reimbursement, records of health services, medical procedures, prescriptions, and diagnoses information. It is clear that such systems may provide a valuable variety of clinical and demographic information as well as an on-going process of data collection. In general, information gathering in these databases does not initially presume and is not planned for research purposes. Nonetheless, administrative databases may be used as a robust research tool. In this article, we address the subject of public health research that employs administrative data. We discuss the biases and the limitations of such research, as well as other important epidemiological and biostatistical key points specific to administrative database studies.
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                Author and article information

                Journal
                The Bone & Joint Journal
                The Bone & Joint Journal
                British Editorial Society of Bone & Joint Surgery
                2049-4394
                2049-4408
                April 2019
                April 2019
                : 101-B
                : 4
                : 470-477
                Affiliations
                [1 ]Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway.
                [2 ]Department of Neurology, Oslo University Hospital, Oslo, Norway.
                [3 ]Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
                [4 ]Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway.
                [5 ]Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
                [6 ]Faculty of Health Science, OsloMet – Oslo Metropolitan University, Oslo, Norway.
                [7 ]Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.
                [8 ]Institute of Clinical Medicine, The Arctic University (UiT) of Norway, Tromsø, Norway.
                [9 ]Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway.
                [10 ]Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
                Article
                10.1302/0301-620X.101B4.BJJ-2018-1184.R1
                30929479
                c2a0884d-68ea-45b7-899d-fc1fdf27544f
                © 2019
                History

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