Incidental durotomy should not preclude same-day discharge from lumbar spine surgery

Abstract

Background context: An incidental durotomy is a common surgical complication that can occur during any spine surgery. Although rarely associated with sequelae requiring intervention, keeping patients who sustained durotomy for overnight observation is a common clinical practice.

Purpose: To determine whether patients who sustained incidental durotomy during lumbar spine surgery can be safely discharged on the day of surgery.

Design: Retrospective cohort study.

Patient sample: Patients who sustained incidental durotomy during elective lumbar microdiscectomy or decompression.

Outcome measures: Outcome measures included complication rates, reoperation rates, readmission rates, patient reported outcome measures (PROMs) and return to activity metrics.

Methods: Over a 7-year study period, 66 patients who sustained an incidental durotomy during elective primary microdiscectomy or decompression were identified. Patients were stratified by their discharge date on either postoperative day (POD) 0 (ambulatory) or POD1-14 (inpatient). A 2-tailed students t-test was utilized to determine if there was a difference in complication rates, PROMs, or return to activity metrics.

Results: Among 66 patients who were identified, 18 were discharged on POD0 and 48 were discharged on POD1-14. Among these patients, only 27 (41%) had the durotomy repaired via primary suture repair. The vast majority utilized a combination of a dural patch and dural sealant. Overall, no significant differences were seen in complication rates, reoperation rates, readmission rates, PROMs, or return to activity metrics between the inpatient and ambulatory groups. For patients that required additional interventions for management of the durotomy, none presented within 48 hours of surgery.

Conclusion: Patients who sustain incidental durotomy during lumbar decompression/microdiscectomy can be safely discharge on the day of surgery if a watertight seal can be obtained via any repair method.

Keywords: Ambulatory spine surgery; Dural tear; Durotomy; Lumbar decompression; Rapid recovery; Surgical outcomes.