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

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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Hybrid Anterior Cervical Discectomy and Fusion and Cervical Disc Arthroplasty: An Analysis of Short-Term Complications, Reoperations, and Readmissions

Global Spine Journal ◽

10.1177/2192568220941453 ◽

2020 ◽

pp. 219256822094145

Author(s):

Venkat Boddapati ◽

Nathan J. Lee ◽

Justin Mathew ◽

Meghana M. Vulapalli ◽

Joseph M. Lombardi ◽

...

Keyword(s):

Perioperative Complications ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Short Term ◽

Hybrid Surgery ◽

Disc Arthroplasty ◽

Cervical Discectomy ◽

Operative Duration ◽

Increased Risk

Study Design: Retrospective cohort study. Objectives: Although cervical disc arthroplasty (CDA) has become a well-established and effective treatment for symptomatic cervical degeneration, many patients with multilevel disease are not good candidates for CDA at all levels. For such patients, hybrid surgery (HS)—a combination of adjacent anterior cervical discectomy and fusion (ACDF) and CDA—may be more appropriate. Given the novelty of HS and the relative dearth of studies adequately assessing short-term perioperative complications, this current study sought to assess the short-term morbidity profile of HS, differences in operative duration, length of stay (LOS), and readmission and reoperation rates and reasons relative to a 2-level ACDF cohort. Methods: All patients who underwent HS and 2-level ACDF were identified between 2011 and 2018 using a large, prospectively collected registry. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis. Results: A total of 390 patients undergoing HS were identified. Two-level procedures were the most common (74.9%). Patients undergoing HS were more likely to be younger, male, and have fewer comorbidities. There were no differences between HS and 2-level ACDF in rates of any postoperative complication, transfusion, readmissions, and operative duration. However, HS had a decreased LOS (0.5 days), relative to a 2-level ACDF. HS patients had low rates of reoperation (1.28%) with 1 case for hematoma evacuation and another for revision CDA. Conclusions: This study represents one of the largest cohorts of patients undergoing HS reported to date. Patients undergoing HS are not at increased risk of perioperative complications relative to a 2-level ACDF and may benefit from shorter LOS.

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Instrumented Outpatient Anterior Cervical Discectomy and Fusion: Is it Safe?

International Surgery ◽

10.9738/cc35.1 ◽

2012 ◽

Vol 97 (1) ◽

pp. 86-89 ◽

Cited By ~ 34

Author(s):

Courtney S Sheperd ◽

William F Young

Keyword(s):

Outpatient Surgery ◽

Cost Savings ◽

Anterior Cervical Discectomy ◽

Ambulatory Setting ◽

Outpatient Basis ◽

Potential Cost ◽

Cervical Discectomy ◽

Hospital Emergency Room ◽

Cervical Swelling ◽

High Degree

Abstract Anterior cervical discectomy and fusion procedures are one of the most common procedures performed in spinal surgery. Increasingly they are being performed on an outpatient basis. The primary impetus for performing procedures as an outpatient is potential cost savings. However, there are few studies discussing the safety of performing the procedure in an ambulatory setting. This is a retrospective review of our initial experience in performing anterior cervical discectomy and fusion procedures with instrumentation (ACDFI) in an ambulatory surgery center dedicated to spine surgery. Patients were selected for outpatient surgery if they had limited co-morbidities and the surgery involved only 1 or 2 levels. One hundred fifty-two patients underwent outpatient ACDFI during the study period (2007–2009). Six patients returned to the hospital emergency room after discharge. The reasons for evaluation included 2 for neck pain, 1 for dysphagia, 1 for vocal cord paralysis and dysphagia, 1 for nausea, and 1 for cervical swelling. Only 1 of the 6 patients required admission to the hospital. None of the 6 suffered any long-term sequelae. The overall complication rate was 3.9%. A self-reported survey was completed by 75 patients within 6 months of surgery, and there was a 100% satisfaction rate among responders. ACDFI can be performed safely on an outpatient in selected patients with a high degree of patient satisfaction. Our experience is consistent with those of previous investigators.

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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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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

The International Journal of Spine Surgery ◽

10.14444/6064 ◽

2019 ◽

Vol 13 (5) ◽

pp. 479-485

Author(s):

KARTIK SHENOY ◽

ABIDEMI ADENIKINJU ◽

EZRA DWECK ◽

AARON J. BUCKLAND ◽

JOHN A. BENDO

Keyword(s):

Anterior Cervical Discectomy ◽

Readmission Rates ◽

Cervical Discectomy ◽

Same Day Discharge

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Abstract P528: Normal Weight Metabolic Obesity and Risk of Coronary Artery Disease: The Million Veteran Program

Circulation ◽

10.1161/circ.141.suppl_1.p528 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Petra Schubert ◽

Yuk-lam Ho ◽

David R Gagnon ◽

Kelly Cho ◽

Peter W Wilson ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

The United States ◽

Normal Weight ◽

Normal Body Mass Index ◽

Metabolic Dysfunction ◽

Obese People ◽

Increased Risk ◽

Secondary Analyses ◽

Artery Disease

Introduction: Obesity and metabolic dysfunction, individually, are known risk factors of stroke, coronary artery disease (CAD), and mortality. However, few studies have examined the long-term risk for CAD among non-obese people with metabolic dysfunction, and no studies have been conducted for Veterans of the United States. Hypothesis: Veterans who are metabolically obese normal weight (MONW) at baseline have an increased risk of developing CAD compared to metabolically healthy normal weight (MHNW) veterans enrolled in the Million Veteran Program (MVP). Methods: We included MVP participants who had a stable normal body mass index (18.5-25kg/m 2 ) five years prior to enrollment. Metabolic obesity was defined as having three or more of the Adult Treatment Panel III criteria [diabetes, hypertension, low HDL-C (≤40 mg/dl for men, ≤50 mg/dl for women), and high triglycerides (≥150 mg/dl)] at enrollment. CAD was defined as non-fatal myocardial infarction, ischemic heart disease or angina pectoris. Participants with prevalent CAD, major cancers and incomplete lifestyle information were excluded. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CAD incidence. In secondary analyses, we stratified by sex and race to evaluate possible effect modification. Results: Of the 16,764 people identified as normal weight with complete data, 15% were MONW, 84.5% were male, 84.4% were White and the mean age was 63.1 ± 14.2. Over a median follow up of 3.6 (IQR 1.8-5.2) years, there were 847 incident CAD events observed. MONW individuals had a 64% (95% CI: 40 -91%) higher risk of CAD compared to normal weight individuals, controlling for age, race, sex, education, smoking status, physical activity, alcohol use and diet. In secondary analyses, we observed a nominally higher risk among women who were MONW [HR (95% CI): 2.74 (1.30-5.77) for women vs. 1.60 (1.37-1.88) for men], however the interaction of MONW and sex was not statistically significant (interaction p=0.19). Similarly, the interaction of MONW and race was not statistically significant [1.62 (1.37-1.92) for White, 1.55 (0.97-2.48) for Black, and 2.26 (1.03-4.95) for other, interaction p=0.83)]. Conclusions: MONW Veterans had a higher risk of CAD compared to MHNW Veterans. This risk was magnified in female Veterans and attenuated in White and Black Veterans compared to other races (Asian, Pacific Islander, Native American, other). These findings will need to be validated in future studies.

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Structural Allograft Versus Synthetic Interbody Cage for Anterior Cervical Discectomy and Fusion: A Comparison of 1-Year Outcomes From a National Database

Global Spine Journal ◽

10.1177/2192568220942217 ◽

2020 ◽

pp. 219256822094221 ◽

Cited By ~ 1

Author(s):

Nandakumar Menon ◽

Justin Turcotte ◽

Chad Patton

Keyword(s):

Propensity Score ◽

Revision Surgery ◽

Perioperative Complications ◽

Anterior Cervical Discectomy ◽

Research Network ◽

National Database ◽

Cervical Discectomy ◽

Single Level ◽

Structural Allograft ◽

Implant Selection

Study Design: Observational cohort study. Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. Methods: The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. Results: A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery ( P = .573), reported diagnoses of pseudoarthrosis ( P = .413), SSI ( P = .620), or dysphagia ( P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). Conclusion: While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.

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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

The Spine Journal ◽

10.1016/j.spinee.2017.07.154 ◽

2017 ◽

Vol 17 (10) ◽

pp. S117

Author(s):

Kyle A. Smith ◽

Paul M. Arnold

Keyword(s):

United States ◽

Resource Utilization ◽

Total Disc Replacement ◽

The United States ◽

Anterior Cervical Discectomy ◽

Disc Replacement ◽

Hospital Resource ◽

Cervical Total Disc Replacement ◽

Cervical Discectomy ◽

Reoperation Rates

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Outcomes After Anterior Cervical Discectomy and Fusion in Professional Athletes

Neurosurgery ◽

10.1227/01.neu.0000429843.68836.91 ◽

2013 ◽

Vol 73 (1) ◽

pp. 103-112 ◽

Cited By ~ 21

Author(s):

Joseph C. Maroon ◽

Jeffrey W. Bost ◽

Anthony L. Petraglia ◽

Darren B. LePere ◽

John Norwig ◽

...

Keyword(s):

Neurological Examination ◽

Full Range ◽

Anterior Cervical Discectomy ◽

Return To Play ◽

Professional Athletes ◽

Adjacent Segment ◽

Contact Sports ◽

Cervical Discectomy ◽

Imaging Results ◽

Increased Risk

Abstract BACKGROUND: Significant controversy exists regarding when an athlete may return to contact sports after anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. OBJECTIVE: The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries. METHODS: Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded. RESULTS: Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs. CONCLUSION: After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP.

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