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

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

Neurosurgery ◽

10.1093/neuros/nyz310_824 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Ketan Yerneni ◽

John F Burke ◽

K Daniel Riew ◽

Vincent C Traynelis ◽

Lee A Tan

Keyword(s):

Perioperative Complications ◽

Meta Analysis ◽

Anterior Cervical Discectomy ◽

Complication Rates ◽

Outpatient Basis ◽

Disc Disease ◽

Level Of Evidence ◽

Cervical Discectomy ◽

Significant Difference ◽

High Level

Abstract INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent surgical procedures and is used to treat several cervical spinal pathologies, including herniated discs, degenerative disc disease, and spondylosis. With the increasing prevalence of ACDF procedures, this procedure has become an excellent target for clinical optimization. Indeed, in recent years, ACDF has become increasingly offered on an outpatient basis. To date, the incidence and dynamics of perioperative complications and safety surrounding outpatient ACDF remain poorly resolved. METHODS We systematically reviewed the literature for articles published by April 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 overall and specific complications between the inpatient and outpatient ACDF 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.

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Comorbidities associated with poor outcomes following operative hammertoe correction in a geriatric population

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00328 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Samuel Maidman ◽

Jason Bariteau ◽

Stephanie Boden ◽

Allison Boden ◽

Shay Tenenbaum

Keyword(s):

Postoperative Complications ◽

Geriatric Patients ◽

Surgical Correction ◽

Physical Component Score ◽

Complication Rates ◽

Geriatric Population ◽

Impaired Wound Healing ◽

Increased Risk ◽

Sf 36 ◽

Poor Outcomes

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are one of the most common lesser foot deformities and are extremely prevalent in the geriatric population. When nonoperative treatment fails, surgical correction can improve functional status and pain. While complications following these surgeries are rare, older patients with comorbid conditions are often considered worse operative candidates due to an increased risk of adverse outcomes. The aim of this study is to determine if specific comorbidities or perioperative variables are associated with increased complications or unsuccessful outcomes following operative hammertoe correction in geriatric patients. Methods: Prospectively collected data was reviewed on 31 consecutive patients aged 60 or older who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, perioperative variables, and postoperative complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component Score (SF-36 PCS) with a minimum of six-month follow-up. Data was examined using Fisher’s method and multivariable analysis. Results: 29.0% (9/31) of patients had a history of smoking, 61.2% (19/31) were on anticoagulant therapy, 19.4% (6/31) had osteoporosis, 16.1% (5/31) had rheumatoid arthritis, and 9.7% (3/31) had diabetes mellitus. The mean tourniquet and operative times were 65.7 (SE=6.2) and 95.4 (SE=7.4) minutes, respectively. Postoperative complications occurred in 12.9% (4/31) of patients with the most prevalent being wound infections that were treated with antibiotics in 9.7% (3/31). Impaired wound healing, joint nonunion, and the need for revision surgery each occurred in 3.2% (1/31) of patients. Mean 6-month improvement in VAS was 2.1 (SE=0.5) and mean improvement in SF-36 PCS was 10.2 (SE = 3.4). No significant association was found between comorbidities or perioperative variables and postoperative complications or improved outcomes. Conclusion: No specific comorbidities or perioperative variables were identified that increase the risk for unsuccessful surgical correction of hammertoe deformities. While comorbidities in the geriatric population have traditionally been thought to increase complication rates and lead to poor outcomes, further research in this area is warranted. Comorbidities should not necessarily be a deterrent for geriatric patients pursuing operative hammertoe correction.

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Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

Journal of Clinical Medicine ◽

10.3390/jcm10040710 ◽

2021 ◽

Vol 10 (4) ◽

pp. 710

Author(s):

Abel Botelho Quaresma ◽

Fernanda da Silva Barbosa Baraúna ◽

Fábio Vieira Teixeira ◽

Rogério Saad-Hossne ◽

Paulo Gustavo Kotze

Keyword(s):

Ulcerative Colitis ◽

Postoperative Complications ◽

Meta Analysis ◽

Qualitative Evaluation ◽

Complication Rates ◽

Surgical Morbidity ◽

Randomized Studies ◽

Pubmed Database ◽

Increased Risk ◽

The Impact

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

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Diabetes Confers Little to No Increased Risk of Postoperative Complications After Hip Fracture Surgery in Geriatric Patients

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3945-7 ◽

2014 ◽

Vol 473 (3) ◽

pp. 1043-1051 ◽

Cited By ~ 19

Author(s):

Nicholas S. Golinvaux ◽

Daniel D. Bohl ◽

Bryce A. Basques ◽

Michael R. Baumgaertner ◽

Jonathan N. Grauer

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Geriatric Patients ◽

Hip Fracture Surgery ◽

Increased Risk ◽

Fracture Surgery

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When can total knee arthroplasty be safely performed following prior arthroscopy?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03859-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Acl Injury ◽

Control Group ◽

Optimal Timing ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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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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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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When can be safely performed total knee arthroplasty following prior arthroscopy?

10.21203/rs.3.rs-38843/v2 ◽

2020 ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Linear Regression Analysis ◽

Acl Injury ◽

Optimal Time ◽

Control Group ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal time to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA; and 3) determine the timing of TKA following prior KA.Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum followup was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an end point. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA.Results The all-cause reoperation, revision and complication rates of KA group were significantly higher than those of control group (p<0.05). The survivorship of KA group and control group was 92.0% and 99.4% at the 2-year followup (p=0.002), respectively. Male (Hazards ratio [HR]=3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR=4.4) were associated with postoperative complications in the KA group. There was a non-liner relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months.Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within 9 months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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