Response to Hoffman M et al.,Risk Factors for Surgical Site Complications After Outpatient Lumbar Spine Surgery (doi: 10.1089/2023.040)

To the Editor:

Recently, we read an article entitled “Risk Factors for Surgical Site Complications After Outpatient Lumbar Spine Surgery” by Hoffman et al. ¹ In an observational study, the authors assessed risk factors for post-operative complications after outpatient lumbar spine surgery. In the context of the increasing promotion of outpatient lumbar spine surgery, the study found that many factors, including the number of spinal levels, were closely related to wound drainage. This study provides strong evidence and support for patient selection for outpatient lumbar surgery and can guide rehabilitation after outpatient lumbar surgery. Of course, while reading the article, we also put forward some of our opinions, hoping to discuss them with the author.

First, the article's title refers to “surgical site complications,” but the writing is mainly aimed at wound drainage. Wound drainage may be a precursor to post-operative infection, but the equivalence between the two remains questionable. In addition to wound infection, surgical site complications include wound hematoma formation, incisional hernia, and sinus/fistula. ² This creates an ambiguity that wound drainage does not represent wound complications, that more post-operative wound indicators may need to be included, or that more care should be taken in title selection.

At present, outpatient surgery is becoming increasingly crucial for spine surgery. In addition to lumbar and cervical spine surgery, outpatient surgery is vigorously carried out, and its safety and economic benefits have been affirmed. ³ This article mainly discusses lumbar spine surgery. In fact, outpatient lumbar spine surgery includes a variety of different surgical methods, and post-operative complications caused by various surgical methods are different. For example, there is a difference in the rate of complication after outpatient surgery between artificial disc replacement (ADR) and anterior lumbar interbody fusion (ALIF), ⁴ even though the difference is not statistically significant. This may be related to factors such as the operation's approach and the procedure's duration. Therefore, the authors must distinguish different lumbar surgery methods to reduce the bias caused by surgery.

We recognize and thank the authors for their contributions. In the future, promoting outpatient spine surgery requires more similar studies to explain and standardize.