title: Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score-matched analysis using a nationwide administrative database.
abstract: OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score-matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43-0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09-0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ohya
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oichi
authors.affiliation: Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo; and.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Departments of 1 Orthopaedic Surgery and.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo; and.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D013116:Spinal Cord / Q000601:surgery*; D013122:Spinal Diseases / Q000401:mortality* / Q000601:surgery*; D018709:Statistics, Nonparametric; D000067369:Transanal Endoscopic Microsurgery / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: BMI = body mass index; CCI = Charlson Comorbidity Index; DPC = Diagnosis Procedure Combination; ICD-10 = International Classification of Diseases, 10th Revision; MED = microendoscopic discectomy; SSI = surgical site infection; complication; endoscopic surgery; lumbar disc herniation; minimally invasive surgery; mortality; surgical site infection