LP on an outpatient basis
While the volume of LPs being performed remain almost the same, there has been an increasing trend to perform LPs on outpatient basis and in the emergency setting and a decrease in the number of inpatient LP ( -37% in the study by kroll et al.,44,817 in 2011 vs 71,385 in 1991).30 Outpatient LPs can reduce the costs of inpatient hospitalizations and also the duration of stay. However, concern remain regarding the efficacy of outpatient primary care providers and safety of outpatient LPs. Barreras et al. retrospectively evaluated elective LPs performed at a resident-run University-Hospital Outpatient LP Clinic between June 1, 2014, and May 31, 2015.31 A total of 282 patients underwent LP. Successful acquisition of CSF was achieved in 267 (94.6 %) patients, and the incidence of Post lumbar Puncture headache (PLPH) was 16%, the same as accepted inpatient complication rate.31 Lambe et al.32 and Popp et al.33 also showed that the complication rate from outpatient LP was 4% and 9 %, respectively, which were mild PLPH and did not require hospitalization. So, a standardized approach via an outpatient LP clinic can have a high rate of successful CSF acquisition and low rates for significant post-procedure complications.