Comparative analysis of anterior cervical discectomy and fusion in the inpatient versus outpatient surgical setting

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OBJECTIVE

In 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.

METHODS

Patients 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.

RESULTS

The 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.

CONCLUSIONS

Although 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.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; ASC = ambulatory surgical center; CCI = Charlson Comorbidity Index; NDI = Neck Disability Index; OME = oral morphine equivalent; POD = postoperative day; VAS = visual analog scale.

Article Information

Correspondence Kern Singh: Rush University Medical Center, Chicago, IL. kern.singh@rushortho.com.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2019.1.SPINE181311.

Disclosures Dr. Singh reports being a consultant for Zimmer Biomet and K2M; being a board member for Vital 5 LLC, TDi LLC, and the Minimally Invasive Spine Study Group; serving on the editorial board for Contemporary Spine Surgery, Orthopedics Today, and Vertebral Columns; receiving royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, and Slack Publishing; and receiving grants from the Cervical Spine Research Society.

© AANS, except where prohibited by US copyright law.

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