Oichi T, et al. - Herein, authors drew a comparison in the postoperative morbidity and mortality after lumbar laminectomy between patients treated with microendoscopic laminectomy (MEL) and open laminectomy. A significantly less likeliness to experience major postoperative complications, to develop surgical site infection and postoperative delirium was noted in those who underwent MEL vs who underwent open laminectomy.

Methods

• Researchers conducted a retrospective cohort study with propensity score-matched analysis.
• They extracted the data of patients who underwent elective spinal surgery between July 2010 and March 2013 from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.
• Length of hospital stay, occurrence of major complications (cardiac events, respiratory complications, pulmonary embolism, stroke and acute renal failure), surgical site infection, postoperative delirium and in-hospital death were the clinical outcomes.
• In order to adjust for measured confounding factors, including patient age, sex, Charlson Comorbidity Index, BMI, smoking status, blood transfusion, duration of anesthesia, number of operated disc levels, type of hospital and hospital volumes they performed propensity score matching.
• Experts compared the clinical outcomes of one-to-one propensity-matched pairs of the MEL and open laminectomy groups.

Results

• Results demonstrated that out of 23,317 patients identified in the database, 1,536 had undergone MEL (6.6%).
• A total of 1,536 pairs were selected using one-to-one propensity score matching.
• A close balance was maintained in the distributions of patient backgrounds between the MEL and open laminectomy groups.
• On analysis of 1,536 pairs they noted that there was a significantly lower incidence of major postoperative complications in those who had undergone MEL (1.0% vs 2.8% for open laminectomy, risk difference 1.8%, 95% confidence interval [CI] 0.9%–2.9%), surgical site infection (0.5% vs 1.6% for open laminectomy, risk difference 1.1%, 95% CI 0.4%–1.9%) and postoperative delirium (1.1% vs 2.3% for open laminectomy, risk difference 1.2%, 95% CI 0.3%–2.1%).
• A significantly shorter length of hospital stay was noted in those treated with MEL (12 days vs 16 days for open laminectomy, p < 0.001).
• As per data, no significant difference in in-hospital mortality between the groups was seen.