# The Impact of the COVID-19 Pandemic on Ambulatory Lumbar Spine Decompression Surgery

## TL;DR

This study examines how the COVID-19 pandemic affected lumbar spine surgeries done in outpatient settings, finding changes in patient age, health, and hospital stays.

## Contribution

The study provides new insights into how pandemic restrictions altered ambulatory spine surgery trends and patient outcomes.

## Key findings

- Patients during the restricted pandemic period were younger and healthier, leading to shorter hospital stays.
- A significant drop in mean length of stay was observed at the start of the restricted period.
- The pandemic was identified as an independent factor affecting post-restricted hospital stay lengths.

## Abstract

Background

Only a few studies have examined the impact of the coronavirus disease 2019 pandemic on spine ambulatory surgeries and changes in trends. Therefore, we investigated trends during the pre-pandemic period and three pandemic stages in patients undergoing lumbar decompression procedures in the ambulatory surgery (AMS) setting.

Methodology

A total of 2,670 adult patients undergoing one- or two-level lumbar decompression surgery were retrospectively reviewed. Patients were categorized into the following four groups: 1: pre-pandemic (before the pandemic from January 1, 2019, to March 16, 2020); 2: restricted period (when elective surgery was canceled from March 17, 2020, to June 30, 2020); 3: post-restricted 2020 (July 1, 2020, to December 31, 2020, before vaccination); and 4: post-restricted 2021 (January 1, 2021 to December 31, 2021 after vaccination). Simple and multivariable logistic regression analyses as well as retrospective interrupted time series (ITS) analysis were conducted comparing AMS patients in the four periods.

Results

Patients from the restricted pandemic period were younger and healthier, which led to a shorter length of stay (LOS). The ITS analysis demonstrated a significant drop in mean LOS at the beginning of the restricted period and recovered to the pre-pandemic levels in one year. Multivariable logistic regression analyses indicated that the pandemic was an independent factor influencing the LOS in post-restricted phases.

Conclusions

As the post-restricted 2020 period itself might be independently influenced by the pandemic, these results should be taken into account when interpreting the LOS of the patients undergoing ambulatory spine surgery in post-restricted phases.