1220 Shorter Hospitalization Observed Following Endoscopic Single-Level Lumbar Decompression Compared to Open Surgery: A Retrospective Analysis Of 2,527 Patients

INTRODUCTION: Endoscopic lumbar decompression is a common surgical intervention for radiculopathy, offering potential benefits over open decompression, such as shorter operative times and faster postoperative recovery. Both endoscopic and open approaches improve patient quality of life, but further studies are needed to fully understand the advantages of the increasingly used endoscopic method. METHODS: Patients at an academic medical center who underwent single-level lumbar nerve root decompression from 2019-2023 via the endoscopic approach were compared to those who underwent open decompression during the same period. Data extracted from electronic health records included demographics, Charlson comorbidity index (CCI), operative time, LOS, and patient-reported outcome measures (PROMs). Student’s t-tests were used to compare differences based on surgical technique. RESULTS: 2527 patients (mean age 60.4 ± 14.8y) underwent lumbar nerve root decompression with either endoscopic (n=112) or open (n=2415) approaches. Endoscopic cases had a significantly lower LOS (0.67 days, IQR: 0 to 1 day) than open cases (1.63 days, IQR: 0 to 2 days), with no significant differences in gender, race, BMI, age, and CCI (p=5.10*10^-8). Patients who underwent endoscopic decompression (-1.55, IQR: -5 to 0) experienced a similar postoperative decrease in pain on the VAS scale as those who had open surgeries (-2.11, IQR: -5 to 0), indicating non-superiority of open approaches compared to fully endoscopic approaches (p=0.083). CONCLUSIONS: Endoscopic lumbar decompression resulted in shorter hospital stays compared to open techniques, while showing non-inferior improvement in pain scores. The shorter LOS is likely due to reduced tissue trauma from smaller incisions and minimal muscle manipulation. Although pain scores were similar between both methods, the reduced LOS with endoscopic techniques may decrease immediate postoperative healthcare utilization.