Prospective evaluation of short-term outcomes following outpatient unilateral biportal endoscopic lumbar decompression in geriatric patients.

PURPOSE: Outpatient surgery is increasingly adopted in spine care, but its feasibility and safety in geriatric patients undergoing endoscopic lumbar decompression remain poorly documented. This study evaluated the feasibility, short-term clinical outcomes, and safety of outpatient endoscopic decompression in patients aged ≥ 75 years. METHODS: A prospective observational study was conducted at a tertiary care center. Patients ≥ 75 years with an indication for outpatient endoscopic lumbar decompression were included. Successful outpatient management was defined as the absence of inpatient admission within 30 days postoperatively. Sociodemographic, clinical, surgical, and functional data were collected preoperatively and at 3 months. RESULTS: Thirty-four patients were included. Significant improvements were observed across all clinical outcomes: lumbar VAS (- 2.0 points), radicular VAS (- 5.2 points), ODI (- 21.5 points), EQ-5D-5 L index (+ 0.30), EQ-VAS (+ 17.6 points), SF-36 PCS (+ 2.9) and MCS (+ 6.5), and walking distance (+ 300 m). Outpatient management was successful in 73% (25/34). Unplanned hospitalization occurred in 27% (9/34), most frequently on the day of surgery, due to inadequate recovery in the post-anesthesia care unit or logistical factors. Chronic kidney disease was more prevalent among patients with unsuccessful outpatient management (33.3% vs. 4.0%; p = 0.04), whereas BMI was higher among patients with successful outpatient management (26.8 [25.0-31.0] vs. 25.6 [23.7-27.2] kg/m²; p = 0.02). No surgical site infections, reoperations, or conversions to open surgery were noted. CONCLUSION: Outpatient unilateral biportal endoscopic lumbar decompression appears feasible in carefully selected geriatric patients and suggests meaningful short-term clinical improvement with an acceptable short-term safety profile. Larger studies are required to confirm these findings and better define optimal patient selection criteria.