Best Practices for Outpatient Anterior Cervical Surgery

Mohandas, Anita; Summa, Chris; Worthington, W Bradley; Lerner, Jason; Foley, Kevin T.; Bohinski, Robert J.; Lanford, Gregory B; Holden, Carol A; Wohns, Richard N. W.

doi:10.1097/brs.0000000000001925

Cited by 42 publications

(22 citation statements)

References 27 publications

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“…Similarly, several groups have created protocols and discharge criteria for outpatient surgery. 15,18,25,31 This includes the empowerment of anesthesia colleagues and nursing staff to improve efficiency and implement safety checkpoints. 41 Furthermore, the utilization of a next-day clinic visit or follow-up telephone call can maintain patient satisfaction as well as preserve safety and outcomes.…”

Section: Patient Selection and Discharge Criteriamentioning

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: Patient Selection and Discharge Criteriamentioning

confidence: 99%

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

Pendharkar

Shahin

et al. 2018

Neurosurgical Focus

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“…It is believed that strict patient selection is important to optimize outcomes and safety of outpatient spine surgeries. [22][23][24][25] However, despite this consensus, currently, there is no evidence-based guideline to help with patient selection.…”

Section: Discussionmentioning

confidence: 99%

“…Except for surgical technique, anesthesiology, and patient selection, discharge criteria also could not be neglected. Mohandas et al 23 suggested that patients underwent outpatient cervical spine surgery should be evaluated with a discharge checklist or scale to determine if they can be safely discharged. However, in the included studies, only Chin et al 17 reported the discharge recommendations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Safety of Outpatient Cervical Disc Replacement With Inpatient Cervical Disc Replacement: A Systematic Review and Meta-Analysis

Wang

Meng

Líu

et al. 2020

Global Spine Journal

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Study Design: A systematic review and meta-analysis. Objectives: Outpatient cervical disc replacement (CDR) has been performed with an increasing trend in recent years. However, the safety profile surrounding outpatient CDR remains insufficient. The present study systematically reviewed the current studies about outpatient CDR and performed a meta-analysis to evaluate the current evidence on the safety of outpatient CDR as a comparison with the inpatient CDR. Methods: We searched the PubMed, Embase, Web of Science, and Cochrane Library databases comprehensively up to April 2020. Patient demographic data, overall complication, readmission, returning to the operation room, operating time were analyzed with the Stata 14 software and R 3.4.4 software. Results: Nine retrospective studies were included. Patients underwent outpatient CDR were significantly younger (mean difference [MD] = −1.97; 95% CI −3.80 to −0.15; P = .034) and had lower prevalence of hypertension (OR = 0.68; 95% CI 0.53-0.87; P = .002) compared with inpatient CDR. The pooled prevalence of overall complication was 0.51% (95% CI 0.10% to 1.13%) for outpatient CDR. Outpatient CDR had a 59% reduction in risk of developing complications (OR = 0.41; 95% CI 0.18-0.95; P = .037). Outpatient CDR showed significantly shorter operating time (MD = −18.37; 95% CI −25.96 to −10.77; P < .001). The readmission and reoperation rate were similar between the 2 groups. Conclusions: There is a lack of prospective studies on the safety of outpatient CDR. However, current evidence shows outpatient CDR can be safely performed under careful patient selection. High-quality, large prospective studies are needed to demonstrate the generalizability of this study.

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“…However, a number of recent retrospective database analyses suggest that successful outpatient anterior cervical fusions can be done without an increased risk of complications 6–8. The surge of outpatient spine surgery, particularly in the USA, is also evident in the recent US-based clinical practice guidelines that advocate early discharge over inpatient care 9…”

Section: Introductionmentioning

confidence: 99%

Finnish Trial on Practices of Anterior Cervical Decompression and Fusion (FACADE): a protocol for a prospective randomised non-inferiority trial comparing outpatient versus inpatient care

investigators

Lönnrot²,

Taimela³

et al. 2019

BMJ Open

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IntroductionAlthough a great majority of patients with cervical radiculopathy syndrome can successfully be treated non-operatively, a considerable proportion experience persistent symptoms, severe enough to require neurosurgical intervention. During the past decade, cervical spine procedures have increasingly been performed on an outpatient basis and retrospective database analyses have shown this to be feasible and safe. However, there are no randomised controlled studies comparing outpatient care with inpatient care, particularly with emphasis on the patients’ perception of symptom relief and their ability to return to normal daily activities and work.Methods and analysisThis is a prospective, randomised, controlled, parallel group non-inferiority trial comparing the traditional hospital surveillance (inpatient, patients staying in the hospital for 1–3 nights after surgery) with outpatient care (discharge on the day of the surgery, usually within 6–8 hours after procedure) in patients who have undergone anterior cervical decompression and fusion procedure. To determine whether early discharge (outpatient care) is non-inferior to inpatient care, we will randomise 104 patients to these two groups and follow them for 6 months using the Neck Disability Index (NDI) as the primary outcome. We expect that early discharge is not significantly worse than the current care in terms of change in NDI. Non-inferiority will be declared if the mean improvement for outpatient care is no worse than the mean improvement for inpatient care, by a margin of 17.3%. We hypothesise that a shorter hospital stay results in more rapid return to normal daily activities, shorter duration of sick leave and decreased secondary costs to healthcare system. Secondary outcomes in our study are arm pain and neck pain using the Numeric Rating Scale, operative success (Odom’s criteria), patient’s satisfaction to treatment, general quality of life (EQ-5D-5L), Work Ability Score, sickness absence days, return to previous leisure activities and complications.Ethics and disseminationThe study was approved by the institutional review board of the Helsinki and Uusimaa Hospital District on 6 June 2019 (1540/2019) and duly registered at ClinicalTrials.gov. We will disseminate the findings of this study through peer-reviewed publications and conference presentations.Trial registration number NCT03979443.

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Best Practices for Outpatient Anterior Cervical Surgery

Abstract: 4.

Cited by 42 publications

References 27 publications

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

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

Comparison of the Safety of Outpatient Cervical Disc Replacement With Inpatient Cervical Disc Replacement: A Systematic Review and Meta-Analysis

Finnish Trial on Practices of Anterior Cervical Decompression and Fusion (FACADE): a protocol for a prospective randomised non-inferiority trial comparing outpatient versus inpatient care

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