[Intra- and postoperative risk analysis after lumbar intervertebral disk operation].
OBJECTIVE
To evaluate the perioperative risks for lumbar disc surgery.


METHODS
Over a 10-year period 558 patients (mean age 45, range from 18 to 83 years; 62.7% male, 37.2% female) underwent conventional lumbar disc nucleotomy (69.4% mono-, 27.3 bi-, and 3.3% tri-segmental) for the first (84.4%), second (12.3%), third (2.3%) or more (1.0%) time. Main levels operated were L4/L5 in 56.3% and L5/S1 in 35.3%. In 63.9% there was a preoperative motor deficit. Before the operation and until 3 months after the operation all complications were recorded.


RESULTS
In 115 (20.6%) of our patients intra- and/or postoperative complications were observed. Of these 115 patients 33 (5.9%) had slight complications (i.e. urinary tract infection, GI tract disturbance, local irritation of the wound), 57 (10.2%) had moderate complications (i.e. respiratory tract infection, superficial wound infection, dural tear), and 25 (4.4%) suffered from severe complications (i.e. deep vein thrombosis, pulmonary embolism, increase of the neurological dysfunction, additional operation because of a complication). Only in severe complications the hospital stay was prolonged (from a mean of 21 days to a mean of 33 days, p < 0.05). Our analysis showed a doubling of the complication risk in patients older than 75 compared to patients younger than 40 years. Multiple regression analysis revealed significant influence of concomitant diseases like diabetes mellitus and hepatitis (p < 0.01).


CONCLUSIONS
25 or 4.4% of all our patients were confronted with severe complications. The indication for nucleotomy should be weighed especially careful in old patients with diabetes mellitus or hepatitis.
Rompe
J D
JD
Orthopädische Universitätsklinik Mainz.
Eysel
P
P
Zöllner
J
J
Heine
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017586:Diskectomy / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment
Intra- und postoperative Risikoanalyse nach lumbaler Bandscheibenoperation.