A Comparison of 30-Day Hospital Readmission and Complication Rates After Outpatient Versus Inpatient 1 and 2 Level Anterior Cervical Discectomy and Fusion Surgery: An Analysis of a Medicare Patient Sample

OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative deaths occurred. The 30-day hospital readmission rate was 2.2%. All 90-day surgical morbidity was similar between outpatient and inpatient cohorts for both 1-level and 2-level ACDFs. CONCLUSIONS An analysis of 1000 consecutive patients who underwent ACDF in an outpatient setting demonstrates that surgical complications occur at a low rate (1%) and can be appropriately diagnosed and managed in a 4-hour ASC PACU window. Comparison with an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising surgical safety. In an effort to decrease costs of care, surgeons can safely perform 1- and 2-level ACDFs in an ASC environment.

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Comparison of Complication Rates Associated with Two-Level Cervical Arthroplasty Versus Two-Level Anterior Cervical Discectomy and Fusion

The Spine Journal ◽

10.1016/j.spinee.2012.08.366 ◽

2012 ◽

Vol 12 (9) ◽

pp. S139-S140 ◽

Cited By ~ 2

Author(s):

Reginald J. Davis ◽

Ali Araghi ◽

Hyun W. Bae ◽

Michael S. Hisey ◽

Pierce D. Nunley

Keyword(s):

Anterior Cervical Discectomy ◽

Complication Rates ◽

Cervical Arthroplasty ◽

Cervical Discectomy

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Cost-Effectiveness of Peptide Enhanced Bone Graft i-Factor versus Use of Local Autologous Bone in Anterior Cervical Discectomy and Fusion Surgery

ClinicoEconomics and Outcomes Research ◽

10.2147/ceor.s318589 ◽

2021 ◽

Vol Volume 13 ◽

pp. 681-691

Author(s):

Bart Thaci ◽

Randy Yee ◽

Kee Kim ◽

Amir Vokshoor ◽

J Patrick Johnson ◽

...

Keyword(s):

Cost Effectiveness ◽

Bone Graft ◽

Factor Versus ◽

Anterior Cervical Discectomy ◽

Fusion Surgery ◽

Cervical Discectomy ◽

I Factor ◽

Autologous Bone

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Anterior cervical spine surgical complications: Safety comparison between teacher and student

Surgical Neurology International ◽

10.25259/sni_876_2020 ◽

2021 ◽

Vol 12 ◽

pp. 43

Author(s):

Edvin Zekaj ◽

Guglielmo Iess ◽

Domenico Servello

Keyword(s):

Critical Factor ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Complication Rates ◽

Years Of Experience ◽

Cervical Discectomy ◽

Phone Calls ◽

Cervical Surgery ◽

Anterior Cervical Surgery

Background: Anterior cervical surgery has a widespread use. Despite its popularity, this surgery can lead to serious and life-threatening complications, and warrants the attention of skilled attending spinal surgeons with many years of experience. Methods: We retrospectively evaluated postoperative complications occurring in 110 patients who underwent anterior cervical surgery (anterior cervical discectomy without fusion, anterior cervical discectomy and fusion, and anterior cervical disc arthroplasty) between 2013 and 2020. These operations were performed by an either an attending surgeon with 30 years’ experience versus a novice neurosurgeon (NN) with <5 years of training with the former surgeon. Complications were variously identified utilizing admission/discharge notes, surgical reports, follow-up visits, and phone calls. Complications for the two groups were compared for total and specific complication rates (using the Pearson’s Chi-square and Fisher’s test). Results: The total cumulative complication rate was 15.4% and was not significantly different between the two cohorts. The most frequent postoperative complication was dysphagia. Notably, there were no significant differences in total number of postoperative instances of dysphagia, dysphonia, unintended durotomy, hypoasthenia, and hypoesthesia; the only difference was the longer operative times for NNs. Conclusion: Surgeons’ years of experience proved not to be a critical factor in determining complication rates following anterior cervical surgery.

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Right-sided chylothorax following left-sided approach anterior cervical discectomy and fusion surgery at the C6-7 level

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.06.006 ◽

2020 ◽

Vol 25 (1) ◽

pp. 193-196

Author(s):

Sangbong Ko ◽

Wonkee Choi ◽

Seungbum Chae

Keyword(s):

Anterior Cervical Discectomy ◽

Fusion Surgery ◽

Cervical Discectomy

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Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Neurosurgery ◽

10.1093/neuros/nyy636 ◽

2019 ◽

Vol 86 (1) ◽

pp. 30-45 ◽

Cited By ~ 7

Author(s):

Ketan Yerneni ◽

John F Burke ◽

Pranathi Chunduru ◽

Annette M Molinaro ◽

K Daniel Riew ◽

...

Keyword(s):

Safety Profile ◽

Meta Analysis ◽

Anterior Cervical Discectomy ◽

Complication Rates ◽

Outpatient Basis ◽

Level Of Evidence ◽

Cervical Discectomy ◽

Significant Difference ◽

Level I ◽

High Level

ABSTRACT BACKGROUND Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE To review the medical literature on the safety of outpatient ACDF. METHODS We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.

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