Search

Background: Outpatient surgery is becoming more common and is more cost-effective than inpatient surgery. Nonetheless, many surgeons and health care administrators are still hesitant to accept outpatient surgery for cervical degenerative spinal disease (C-DSD). This study assesses the types and rates of complications, hospital admissions, and reoperations after outpatient surgery of C-DSD.Methods: Complications, hospital admissions within 90 days of surgery, and reoperations within one year of surgery were recorded retrospectively in 1300 outpatients undergoing microsurgical decompression for C-DSD at the Oslofjord Clinic from 2008 to 2017. The surgical procedures performed were anterior cervical decompression and fusion (ACDF) in 1083 patients and posterior cervical foraminotomy in 217 patients.Results: The surgical mortality rate was 0%. Sixteen major complications were recorded in 15/1300 (1.2%) patients. The complications were neurological deterioration in four patients, postoperative hematoma in two, dural lesions with cerebrospinal fluid leakage in one, deep surgical-site infection in one, persistent hoarseness in three, and persistent dysphagia in five. The two potentially life-threatening hematomas were detected within the planned six-hour observation period. Two (0.2%) patients were admitted to hospital within hours of surgery completion with stroke-like signs and symptoms, and four (0.3%) patients were admitted to hospital within 90 days due to surgery-related events. The rate of reoperations for cervical radiculopathy within 12 months was 25/1171 (2%); eight patients' reoperations were due to inadequate primary decompression, one was due to recurrent disc herniation at the same level and side, and 16 were due to new-onset radiculopathy from an adjacent level or other side.Conclusions: Outpatient microsurgical decompression of the degenerative cervical spine in carefully selected patients appears to be safe and carries a low major complication rate, low hospital admission rate, and low one-year reoperation rate.

BACKGROUND: There is an increasing demand for surgery of degenerative spinal disease. Limited healthcare resources draw attention to the need for cost-effective treatments. Outpatient surgery, when safe and feasible, is more cost effective than inpatient surgery. OBJECTIVE: To study types and rates of complications after outpatient lumbar and cervical spine decompressions. METHODS: Complications were recorded prospectively in 1449 (1073 lumbar, 376 cervical) outpatients undergoing microsurgical decompression for degenerative spinal disease at the private Oslofjord Clinic from 2008 to 2013. RESULTS: Surgical mortality was 0%. A total of 51 (3.5%) minor and major complications were recorded in 51 patients. Three (0.2%) patients had to be admitted to a hospital the day of surgery. Twenty-two (1.5%) patients were admitted to a hospital within 3 months due to surgery-related events. The encountered complications were postoperative hematoma (0.6%), neurological deterioration (0.3%), deep wound infection (0.9%), dural lesions with cerebrospinal fluid leakage (1.0%), persistent dysphagia (0.1%), persistent hoarseness (0.1%), and severe pain/headache (0.4%). All of the life-threatening hematomas were detected within 6 and 3 hours after cervical and lumbar surgery, respectively. CONCLUSION: This series of 1449 consecutive outpatient microsurgical spine decompressions adds to the growing literature in favor of outpatient spinal surgery in properly selected patients. In our study, 99.8% of the patients were successfully discharged either to their homes or to a hotel on the day of surgery. The overall complication rate was 3.5%, surgical mortality was 0%, and only 1.5% had to be admitted to a hospital within 3 months after surgery. publishedVersion

Objectives To evaluate surgical complications and clinical outcome in a consecutive series of 96 patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical disk degeneration (CDD) in an outpatient setting. Methods Pre-, per-, and postoperative data on patients undergoing single- or two-level outpatient ACDF at the private Oslofjord Clinic were prospectively collected. Results This study includes 96 consecutive patients with a mean age of 49.1 years. 36/96 had a two-level ACDF. Mean postoperative observation time before discharge was 350 min, and 95/96 were successfully discharged either to their home or to a hotel on the day of surgery. The surgical mortality was 0%, while the surgical morbidity rate was 5.2%. Two (2.1%) patients developed postoperative hematoma, 2 (2.1%) patients experienced postoperative dysphagia, and 1 (1%) experienced deterioration of neurological function. Radicular pain, neck pain, and headache decreased significantly after surgery. 91% of patients were satisfied with the surgery, according to the NASSQ. Conclusion ACDF in carefully selected patients with CDD appears to be safe in the outpatient setting, provided a sufficient postoperative observation period. The clinical outcome and patient satisfaction of outpatients are comparable to that of inpatients.

OBJECTIVE: We sought to determine the incidence of seizures among patients treated with endovascular coil embolization for ruptured intracranial aneurysms because data on which to base antiepileptic drug (AED) prescriptions and advice to patients regarding driving motor vehicles and other high-risk activities are currently lacking. METHODS: We conducted a single-institute, single-operator observational study of 243 patients referred for endovascular treatment after aneurysmal subarachnoid hemorrhage. Prospective data collection was performed, and all successfully treated patients were followed. The incidence of seizures was compared with published surgical data, and logistic regression analysis of potential clinical associations was performed. Patients were followed for up to 7.7 years (mean follow-up period, 21.9 mo). RESULTS : Ictal seizures occurred at the time of subarachnoid hemorrhage in 26 (11%) of 243 patients and correlated with middle cerebral artery aneurysm location, loss of consciousness at ictus, and AED prescription. No patients experienced periprocedural seizures during their hospitalization. Seven of 233 successfully treated patients (3%) experienced seizures more than 30 days alter treatment: late seizures occurred de novo in four patients (1.7%) and in three patients (1.4%) were caused by preesisting epilipsy. Two patients (0.85%) who had de novo seizures developed epilepsy. Late seizures correlated with a history of previous seizures, the presence of a cerebrospinal fluid shunt, and the use of AEDs. CONCLUSION: The low incidence of seizures does not justify the use of prophylctic AED therapy after aneurysmal subarachnoid hemorrhage in patients treated solely with coil embolization, nor does it justify subsequent restrictions on the driving of motor vehicles if the patient is otherwise fit to drive.

Objective To explore the controversial issue of anticoagulant therapy and indications for surgery in association with severe sinus thrombosis. Methods During the last 4 years, we have treated three patients with severe sinus thrombosis of the dural sinuses. All three patients received systemic anticoagulant therapy and, after experiencing neurological deterioration, underwent open thrombectomy and local thrombolysis. After the operation, aggressive intensive care was given and included cerebral perfusion monitoring, barbiturate administration, hyperventilation, and osmotherapy. The treatment was guided by repeated neuroradiological investigations. Results All three patients returned to their normal lives. Conclusion Intracranial sinus thrombosis, even in the worst neurological state, should be treated aggressively. A cornerstone in treatment is systemic anticoagulant therapy and repeated neuroradiological studies. When, despite adequate anticoagulant therapy and intensive care, neurological deterioration occurs, a combination of open thrombectomy and local thrombolytic therapy should be considered.