Ambulatory anterior cervical discectomy and fusion is associated with a higher risk of revision surgery and perioperative complications: an analysis of a large nationwide database

Arshi, Armin; Wang, Christopher; Park, Howard Y.; Blumstein, Gideon; Buser, Zorica; Wang, Jeffrey C.; Shamie, Arya Nick; Park, Don Y.

doi:10.1016/j.spinee.2017.11.012

Cited by 45 publications

(42 citation statements)

References 28 publications

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“…Arshi et al examined more than 12,000 patients in a private insurance database and reported that outpatient ACDF was associated with higher odds of repeat anterior surgery at 1 year (OR 1.46) as well as a higher likelihood of undergoing posterior surgery at 6 months and 1 year (ORs 1.58 and 1.79, respectively). 3 The authors speculate that pressures for high throughput in an ambulatory setting may force surgeons to be less rigorous in endplate preparation, discectomy, or proper instrumentation, leading to higher rates of pseudarthrosis. Another interesting theory posits that the bias against the treatment of more than 2 levels may increase the proportion of patients with untreated milder adjacent segment disease, which subsequently progresses.…”

Section: Anterior Cervical Discectomy and Fusionmentioning

confidence: 99%

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Pendharkar

Shahin

et al. 2018

Neurosurgical Focus

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Spine surgery is a key target for cost reduction within the United States health care system. One possible strategy involves the transition of inpatient surgeries to the ambulatory setting. Lumbar laminectomy with or without discectomy, lumbar fusion, anterior cervical discectomy and fusion, and cervical disc arthroplasty all represent promising candidates for outpatient surgeries in select populations. In this focused review, the authors clarify the different definitions used in studies describing outpatient spine surgery. They also discuss the body of evidence supporting each of these procedures and summarize the proposed cost savings. Finally, they examine several patient- and surgeon-specific considerations to highlight the barriers in translating outpatient spine surgery into actual practice.

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Section: Anterior Cervical Discectomy and Fusionmentioning

confidence: 99%

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Pendharkar

Shahin

et al. 2018

Neurosurgical Focus

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“…6 However, Arshi et al had reported that ambulatory ACDF had higher peri-operative complications as analyzed from a nationwide database with more than ten thousand patients. 7 At the same time, a more conservative post-operative airway management protocol was proposed to keep the patient intubated overnight if there was the presence of any risk factors. 8 For the timing of the acute complications, Lied et al identified 94.4% (17/18) of the immediate to early complications occurred within 6 hours after the operations.…”

Section: Discussionmentioning

confidence: 99%

Safety for cervical corpectomy and diskectomy: univariate and multivariate analysis on predictors for prolonged ICU stay after anterior spinal fusion

Chan

Mak

Sun

et al. 2020

British Journal of Neurosurgery

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Aim: Cervical anterior spinal fusion (ASF) with corpectomy has risks of catastrophic acute complications such as airway obstruction requiring re-intubation. Our team has adopted a management plan for all cervical corpectomy patients to be admitted to the intensive care unit (ICU) after the operations for overnight observation. Some of these patients were kept intubated after the operations and transferred to the ICU. This study aims to review the outcome of this practice and to identify independent predictors associated with a prolonged ICU stay. Methods: We reviewed consecutive patients with cervical ASF from January 2010 to June 2018. The primary outcome was the ICU length of stay. Univariate and multivariate analyses were conducted to identify independent risk factors associated with a prolonged ICU stay. In total, 103 patients had ASF during the study period. ICU length of stay for elective ASF was 1.01 day (SD 0.373 days) and was significantly shorter than that for emergency ASF (13.29 days, SD 12.57 days) (p < 0.001). 79.6% (82/103) of the ASF patients were extubated in the operating theatre after surgery. Significantly more corpectomy patients (33.3%) versus ACDF patients (15.1%) were kept intubated to the ICU after the operation (p ¼ 0.037). None required reintubation in the ICU. 90.9% (80/88) of the elective ASF can be discharged from the ICU within 24 hours and only 3.41% (3/88) of the elective ASF had prolonged post-operative stay in the ICU (!48 hours). Results: For prolonged postoperative ICU stay (!48 hours), ICU admission airway status of ASF patients who were either extubated in the OT or kept intubated to ICU had no significant association (p ¼ 0.903). Univariate and multivariate analysis had identified emergency admissions (p ¼ 0.043) and the presence of postoperative neurological deficits (p ¼ 0.031) as independent predictors associated with a prolonged postoperative ICU stay. Conclusion: In conclusion, cervical corpectomy and ASF were safe with minimal acute complications.

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“…Such as dysphagia, unilateral recurrent laryngeal nerve palsies, accidental esophageal perforation, cerebrospinal fluid leakage and temporary unilateral Horner syndrome. [ 8 , 9 ] However, posterior percutaneous endoscopic cervical diskectomy (P-PECD) may avoid the above complications. Especially the improvement of the endoscopic instruments has allowed the P-PECD increases its usefulness.…”

Section: Introductionsmentioning

confidence: 99%

Posterior percutaneous endoscopic versus traditional surgery for cervical disc herniation

Sun¹,

Wen

Bing-lin³

et al. 2020

Medicine

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Background: Posterior percutaneous endoscopic cervical diskectomy (P-PECD) can be used posterior microdiscectomy for cervical disc herniation. But only some small sample sizes of clinical studies have evaluated the efficacy and safety of P-PECD. This study aim to evaluated the efficacy and safety of P-PECD compared with traditional open surgery. Methods: We will search the following seven electronic databases from their initiation to the May 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM) and Wanfang database. All randomized controlled trials, non-randomized controlled trials and retrospective case controls that compared the efficacy and safety of P-PECD and traditional open surgery in the treatment of cervical disc herniation will be included. The pooled odds ratio with 95% credible intervals (CIs) was used for the dichotomous variables. The mean difference with 95% CIs was used for the continuous variables. All analyses were conducted by Comprehensive Meta Analysis 2.0. A 2-tailed P value < 0.05 is considered statistically significant. Results: The results of systematic review and meta-analysis will be submitted to a peer-reviewed journal. Conclusion: Our study will provide clarity regarding for clinicians to choices best surgical approach for patients with cervical disc herniation. Any changes that need to be made during the process of this study will be explained in the final full-text publication. Protocol registration number: CRD42020164011.

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Ambulatory anterior cervical discectomy and fusion is associated with a higher risk of revision surgery and perioperative complications: an analysis of a large nationwide database

Cited by 45 publications

References 28 publications

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Safety for cervical corpectomy and diskectomy: univariate and multivariate analysis on predictors for prolonged ICU stay after anterior spinal fusion

Posterior percutaneous endoscopic versus traditional surgery for cervical disc herniation

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