Same-Day Anterior Cervical Discectomy and Fusion—Our Protocol and Experience: Same-Day Discharge After Anterior Cervical Discectomy and Fusion in Suitable Patients has Similarly Low Readmission Rates as Admitted Patients

Study Design: Retrospective study. Objective: To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. Methods: OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch’s t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. Results: OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). Conclusion: The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.

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Outpatient and Inpatient Readmission Rates of 1- and 2-Level Anterior Cervical Discectomy and Fusion Surgeries

World Neurosurgery ◽

10.1016/j.wneu.2019.03.124 ◽

2019 ◽

Vol 126 ◽

pp. e1475-e1481

Author(s):

Syed I. Khalid ◽

Adam Carlton ◽

Rita Wu ◽

Ryan Kelly ◽

Akhil Peta ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Readmission Rates ◽

Cervical Discectomy

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Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries

Journal of Neurosurgery Spine ◽

10.3171/2019.1.spine181019 ◽

2019 ◽

Vol 31 (1) ◽

pp. 70-75 ◽

Cited By ~ 1

Author(s):

Syed I. Khalid ◽

Ryan Kelly ◽

Adam Carlton ◽

Owoicho Adogwa ◽

Patrick Kim ◽

...

Keyword(s):

Outpatient Surgery ◽

Perioperative Complications ◽

The United States ◽

Anterior Cervical Discectomy ◽

Ambulatory Setting ◽

Readmission Rates ◽

Cervical Discectomy ◽

Increased Risk ◽

Artery Disease ◽

Lost To Follow Up

OBJECTIVEWith the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).METHODSThis was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.RESULTSAnalysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.CONCLUSIONSThis study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.

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Patient Factors Affecting Emergency Department Utilization and Hospital Readmission Rates After Primary Anterior Cervical Discectomy and Fusion

Spine ◽

10.1097/brs.0000000000003058 ◽

2019 ◽

Vol 44 (15) ◽

pp. 1078-1086 ◽

Cited By ~ 2

Author(s):

Evan D. Sheha ◽

Stephan N. Salzmann ◽

Sariah Khormaee ◽

Jingyan Yang ◽

Federico P. Girardi ◽

...

Keyword(s):

Emergency Department ◽

Hospital Readmission ◽

Anterior Cervical Discectomy ◽

Emergency Department Utilization ◽

Readmission Rates ◽

Patient Factors ◽

Factors Affecting ◽

Cervical Discectomy ◽

Hospital Readmission Rates

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A comparison of readmission and complication rates and charges of inpatient and outpatient multiple-level anterior cervical discectomy and fusion surgeries in the Medicare population

Journal of Neurosurgery Spine ◽

10.3171/2019.3.spine181257 ◽

2019 ◽

Vol 31 (4) ◽

pp. 486-492 ◽

Cited By ~ 1

Author(s):

Syed I. Khalid ◽

Ryan Kelly ◽

Rita Wu ◽

Akhil Peta ◽

Adam Carlton ◽

...

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Anterior Cervical Discectomy ◽

Complication Rates ◽

Outpatient Basis ◽

Readmission Rates ◽

Surgical Interventions ◽

Cervical Discectomy ◽

Outpatient Procedures ◽

Increased Risk

OBJECTIVEThis study aims to assess the relationship of comorbidities and postoperative complications to rates of readmission for geriatric patients undergoing anterior cervical discectomy and fusion (ACDF) involving more than 2 levels on an inpatient or outpatient basis. With the rising costs of healthcare in the United States, understanding the safety and efficacy of performing common surgical interventions (including ACDF) as outpatient procedures could prove to be of great economic impact.Objective This study aims to assess the effect of comorbidities and postoperative complications on the rates of readmission of geriatric patients undergoing multilevel anterior cervical discectomy and fusion (ACDF) procedures (i.e., ACDF involving 3 or more levels) on an inpatient or outpatient basis. Same-day surgery has been demonstrated to be a safe and cost-effective alternative to the traditional inpatient option for many surgical interventions. With the rising costs of healthcare, understanding the safety and efficacy of performing common surgical interventions as outpatient procedures could prove to be of great economic impact.METHODSThe study population included total of 2492 patients: 2348 inpatients and 144 outpatients having ACDF procedures involving 3 or more levels in the Medicare Standard Analytical Files database. Age, sex, comorbidities, postoperative complications, readmission rates, and surgical procedure charges were compared between both cohorts. For selected variables, logistic regression was used to model odds ratios for various comorbidities against readmission rates for both inpatient and outpatient cohorts. Chi-square tests were also calculated to compare these comorbidities with readmission in each cohort.RESULTSOverall complication rates within 30 postoperative days were greater for inpatients than for outpatients (44.2% vs 12.5%, p < 0.001). More inpatients developed postoperative urinary tract infection (7.9% vs 0%, p < 0.001), and the inpatient cohort had increased risk of readmission with comorbidities of anemia (OR 1.52, p < 0.001), smoking (OR 2.12, p < 0.001), and BMI ≥ 30 (OR 1.43, p < 0.001). Outpatients had increased risk of readmission with comorbidities of anemia (OR 2.78, p = 0.047), diabetes mellitus type 1 or 2 (OR 3.25, p = 0.033), and BMI ≥ 30 (OR 3.95, p = 0.008). Inpatients also had increased readmission risk with a postoperative complication of surgical site infection (OR 2.38, p < 0.001). The average charges for inpatient multilevel ACDF were significantly higher than for multilevel ACDF performed on an outpatient basis ($12,734.27 vs $12,152.18, p = 0.0019).CONCLUSIONSThis study suggests that ACDF surgery involving 3 or more levels performed as an outpatient procedure in the geriatric population may be associated with lower rates of readmissions, complications, and surgical charges.

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