Feasibility and safety of outpatient spine surgery: insights from 555 neurosurgical interventions.
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PURPOSE: This study aims to determine the feasibility of outpatient neurosurgery, which modern microsurgery enables through minimally invasive, tissue-sparing, and low-risk spinal procedures. Outpatient care offers several advantages, including rapid return to the home environment, avoidance of hospital-acquired infections and multi-resistant germs, significant cost savings, and increased patient satisfaction. METHODS: Between October 2023 and May 2025, a total of 555 patients underwent surgery at our outpatient neurosurgical center. The procedures performed included; Lumbar spinal canal decompression: 287 cases (51.7%), Microdiscectomy for lumbar disc herniation: 124 cases (22.3%), Extradural tumor resection: 53 cases (9.5%), Removal of spinal implants: 37 cases (6.7%), Cervical posterior foraminotomy 18 cases (3.2%), Spinal cord stimulation (implantation): 16 cases (2.9%), Percutaneous balloon kyphoplasty: 7 cases (1.3%), Sacral Tarlov cyst fenestration or occlusion: 7 cases (1.3%), Baclofen or morphine pump implantation: 6 cases (1.1%). Each patient was monitored for three to four hours in the recovery area following surgery. Discharge was approved once the patient was fully mobilized and had voided spontaneously. Notably, no surgical drains were used in any of the cases. The age of patients ranged from 15 to 88 years. Gender distribution was 46% male and 54% female. According to the American Society of Anesthesiologists (ASA) physical status classification, 32% of patients were categorized as ASA I, 59% as ASA II 32% and 9% as ASA III. RESULTS: Home care was clarified in advance. There were 5 Cases (1.2%) of postoperative secondary haemorrhages within the first four hours which were revised immediately with complete recovery. In 32 (5,7%) patients, the dura was accidentally injured, of which three patients required revision with a delay due to a symptomatic cerebrospinal fluid collection. Three patients experienced a deterioration of neurological status after the dural injury, of whom two improved completely within 8 weeks and through inpatient treatment. There were three cases of wound dehiscence which were treated conservatively and 17 (3,0%) Cases with superficial wound infection. One patient deteriorated directly after intubation before starting the operation and passed away two days later of cardiopulmonary failure. CONCLUSION: Ambulatory care for uncomplicated lumbar spine conditions is feasible, safe, and effective. It saves significant costs, increases patient satisfaction, and relieves the burden on large hospitals. In particular, patient waiting times for surgery were reduced.