Anterior Cervical Discectomy and Fusion in Outpatient vs Hospital Settings: Length of Stay, Charge, and Complications in Two National Databases

OBJECTIVEIn a large, consecutive series of patients treated with anterior cervical discectomy and fusion (ACDF) performed by a single surgeon, the authors compared the clinical and surgical outcomes of patients who underwent ACDF in an inpatient versus outpatient setting.METHODSPatients undergoing primary ACDF were retrospectively reviewed and stratified by surgical setting: hospital or ambulatory surgical center (ASC). Data regarding perioperative characteristics, including hospital length of stay and complications, were collected. Neck Disability Index (NDI) and visual analog scale (VAS) scores were used to analyze neck and arm pain in the preoperative period and at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Postoperative outcomes were compared using chi-square analysis and linear regression.RESULTSThe study included 272 consecutive patients undergoing a primary ACDF, of whom 172 patients underwent surgery at a hospital and 100 patients underwent surgery at an ASC. Patients undergoing ACDF in the hospital setting were older, more likely to be diabetic, and had a higher comorbidity burden. Patients receiving treatment in the ASC were more likely to carry Workers’ Compensation insurance. Patients in the hospital cohort were more likely to have multilevel procedures, had greater blood loss, and experienced a longer length of stay. In the hospital cohort, 48.3% of patients were discharged within 24 hours, while 43.0% were discharged between 24 and 48 hours after admission. Both cohorts had similar VAS pain scores on postoperative day (POD) 0; however, the hospital cohort consumed more narcotics on POD 0. One patient in the ASC cohort had a pretracheal hematoma that was evacuated immediately in the same surgical center. There were 8 cases of dysphagia in the hospital cohort and 3 cases in the ASC cohort, all of which resolved before the 6-month follow-up. Both cohorts demonstrated similar NDI and VAS neck and arm pain scores preoperatively and at every postoperative time point.CONCLUSIONSAlthough patients undergoing ACDF in the hospital setting were older, had a greater comorbidity burden, and underwent surgery on more levels than patients undergoing ACDF at an outpatient center, this study demonstrated comparable surgical and clinical outcomes for both patient groups. Based on the results of this single surgeon’s experience, 1- to 2-level ACDFs may be performed successfully in the outpatient setting in appropriately selected patient populations.

Download Full-text

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion

Spine ◽

10.1097/brs.0000000000004127 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Emily K. Chapman ◽

Tahera Doctor ◽

Jonathan S. Gal ◽

William H. Shuman ◽

Sean N. Neifert ◽

...

Keyword(s):

Length Of Stay ◽

Cost Of Care ◽

Anterior Cervical Discectomy ◽

Elective Admission ◽

Cervical Discectomy ◽

The Impact

Download Full-text

The influence of social determinants of health on single-level anterior cervical discectomy and fusion outcomes

Journal of Neurosurgery Spine ◽

10.3171/2021.9.spine211059 ◽

2021 ◽

pp. 1-6

Keyword(s):

Length Of Stay ◽

Postoperative Complication ◽

Social Determinants Of Health ◽

Social Determinants ◽

Revision Surgery ◽

Determinants Of Health ◽

Anterior Cervical Discectomy ◽

Complication Rates ◽

Cervical Discectomy ◽

Single Level

OBJECTIVE Methods of reducing complications in individuals electing to undergo anterior cervical discectomy and fusion (ACDF) rely upon understanding at-risk patient populations, among other factors. This study aims to investigate the interplay between social determinants of health (SDOH) and postoperative complication rates, length of stay, revision surgery, and rates of postoperative readmission at 30 and 90 days in individuals electing to have single-level ACDF. METHODS Using MARINER30, a database that contains claims information from all payers, patients were identified who underwent single-level ACDF between 2010 and 2019. Identification of patients experiencing disparities in 1 of 6 categories of SDOH was completed using ICD-9 and ICD-10 (International Classifications of Diseases, Ninth and Tenth Revisions) codes. The population was propensity matched into 2 cohorts based on comorbidity status: those with SDOH versus those without. RESULTS A total of 10,030 patients were analyzed; there were 5015 (50.0%) in each cohort. The rates of any postoperative complication (12.0% vs 4.6%, p < 0.001); pseudarthrosis (3.4% vs 2.6%, p = 0.017); instrumentation removal (1.8% vs 1.2%, p = 0.033); length of stay (2.54 ± 5.9 days vs 2.08 ± 5.07 days, p < 0.001 [mean ± SD]); and revision surgery (9.7% vs 4.2%, p < 0.001) were higher in the SDOH group compared to patients without SDOH, respectively. Patients with any SDOH had higher odds of perioperative complications (OR 2.8, 95% CI 2.43–3.33), pseudarthrosis (OR 1.3, 95% CI 1.06–1.68), revision surgery (OR 2.4, 95% CI 2.04–2.85), and instrumentation removal (OR 1.4, 95% CI 1.04–2.00). CONCLUSIONS In patients who underwent single-level ACDF, there is an association between SDOH and higher complication rates, longer stay, increased need for instrumentation removal, and likelihood of revision surgery.

Download Full-text

Cervical Total Disc Replacement and Anterior Cervical Discectomy and Fusion: Reoperation Rates, Complications, and Hospital Resource Utilization in 72 688 Patients in the United States

Neurosurgery ◽

10.1093/neuros/nyx289 ◽

2017 ◽

Vol 82 (4) ◽

pp. 441-453 ◽

Cited By ~ 13

Author(s):

Kavelin Rumalla ◽

Kyle A Smith ◽

Paul M Arnold

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Total Disc Replacement ◽

Surgical Care ◽

The United States ◽

Anterior Cervical Discectomy ◽

Disc Replacement ◽

Cervical Discectomy ◽

Discharge Disposition ◽

Lower Complication

Abstract BACKGROUND Healthcare readmissions are important causes of increased cost and have profound clinical impact. Thirty-day readmissions in spine surgery have been well documented. However, rates, causes, and outcomes are not well understood outside 30 d. OBJECTIVE To analyze 30- and 90-d readmissions for a retrospective cohort of anterior cervical discectomy and fusions (ACDF) and total disc replacement (TDR) for degenerative cervical conditions. METHODS The Nationwide Readmissions Database approximates 50% of all US hospitalizations with patient identifiers to track patients longitudinally. Patients greater than 18 yr old were identified. Rates of readmission for 30 and 90 d were calculated. Predictor variables, complications, outcomes, and costs were analyzed via univariate and multivariable analyses. RESULTS Between January and September 2013, 72 688 patients were identified. The 30- and 90-d readmission rates were 2.67% and 5.97%, respectively. The most prevalent reason for 30-d readmission was complication of medical/surgical care (20.3%), whereas for 90-d readmission it was degenerative spine etiology (19.2%). Common risk factors for 30- and 90-d readmission included older age, male gender, Medicare/Medicaid, prolonged initial length of stay, and various comorbidities. Unique risk factors for 30- and 90-d readmissions included adverse discharge disposition and mechanical implant-related complications, respectively. When comparing ACDF and TDR, ACDFs were associated with increased 90-d readmissions (6.0% vs 4.3%). The TDR cohort had a shorter length of stay, lower complication rate, and fewer adverse discharge dispositions. CONCLUSION Identification of readmission causes and predictors is important to potentially allow for changes in periperative management. Decreasing readmissions would improve patient outcomes and reduce healthcare costs.

Download Full-text