Are lumbar drains necessary after outpatient lumbar interbody fusion using less exposure surgery techniques?

Abstract

Objective: The use of postoperative drains for elective spine surgery has not been justified. In transitioning to the outpatient setting there may be concerns for haematoma formation in same day procedures. The purpose of the study is to evaluate the outcomes of lumbar spine surgery with no drains in the outpatient setting compared to the inpatient setting. Methods:The medical records of prospectively collected data for 170 patients who had single-level posterior lumbar interbody fusion (PLIF) were retrospectively reviewed. T wo equal cohort groups of 85 patients were assessed, inpatients in which PLIF with drains was performed in the hospital setting, and outpatients with PLIF without drains was performed in the ambulatory surgery centre (ASC). Results: Eighty-nine males and 81 females, overall mean age 53.7 ± 1.4 years and mean body mass index (BMI) 28.3 ± 0.6. Inpatient pre-operative oswestry disability index (ODI) score improved from 50.3 ± 1.8 to 36.3 ± 1.3 at final follow-up, p < 0.001. Outpatient pre-operative ODI means reduced from 46.2 ± 1.6 to 29.2 ± 0.9, p < 0.001. There were significant improvement in ODI scores in Group 2 compared to Group 1, p = 0.001. Mean operative times difference of 62 minutes revealeda statistically significant decrease in the outpatient group, p = 0.003. Four patients (5%) developed postoperative haematoma in the Group with drains, this was significantly more than patients without drains,p = 0.04. Conclusion: Single-level PLIF can be safely done in the outpatient setting without the use of drains. This can be attributed to operative time reduction, less exposure surgery techniques and the use of haemostatic agents.