Comparison of Inpatient and Outpatient Preoperative Factors and Postoperative Outcomes in 2-Level Cervical Disc Arthroplasty

Abstract

ObjectiveThe purpose of this study was to evaluate factors associated with inpatient admission following 2-level cervical disc arthroplasty (CDA). A secondary aim was to compare outcomes between those treated on an inpatient versus outpatient basis. MethodsUsing data from the American College of Surgeons National Surgical Quality Improvement Program database, multivariate logistic regression analysis was used to assess the independent effect of each variable on inpatient or outpatient selection for surgery. Statistical significance was defined by p-values <0.05. The factors considered were age, sex, body mass index (BMI), smoking status, American Society of Anesthesiologists physical status classification, and comorbidities including hypertension, diabetes, history of dyspnea or chronic obstructive pulmonary disease, previous cardiac intervention or surgery, steroid usage, and history of bleeding. In addition, whether the operation was performed by an orthopedic or neurosurgical specialist was analyzed. ResultsThe number of 2-level CDA procedures increased from 6 cases reported in 2014 to 142 in 2016, although a statistically significant increase in the number of outpatient cases performed was not seen (p=0.2). The factors found to be significantly associated with inpatient status following surgery were BMI (p=0.019) and diabetes mellitus requiring insulin (p=0.043). There were no significant differences in complication and readmission rates between the inpatient and outpatient groups. ConclusionPatients undergoing inpatient 2-level CDA had significantly higher rates of obesity and diabetes requiring insulin than did patients undergoing the same procedure in the outpatient setting. With no difference in complication or readmission rates, 2-level CDA may be considered safe in the outpatient setting in appropriately selected patients.

Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement

“…1,2 With continued improvements in technology and devices, recent studies have demonstrated excellent medium-to longterm outcomes following CDR in properly selected patients. [3][4][5][6][7][8] Compared to ACDF especially, CDR has shown equally if not more superior outcomes in various measures: PROMs, patient satisfaction, rate of postoperative dysphagia, rate of revision surgeries or secondary surgeries, adjacent segment degeneration, and cost-effectiveness. [9][10][11][12][13][14][15][16][17][18] It is currently accepted that maintaining or increasing cervical lordosis is an important goal in the surgical treatment of cervical spondylotic myeloradiculopathy.…”

“…Cervical disc replacement (CDR) has been established as a safe and effective surgical option for patients with degenerative disc disease who fail nonoperative management, [1][2][3][4][5][6][7][8] with numerous studies demonstrating similar or superior outcomes in various measures, including adjacent segment pathology, patientreported outcome measures (PROMs), rate of dysphagia, patient satisfaction, rate of revision and secondary surgeries, and cost-effectiveness compared to anterior cervical discectomy and fusion (ACDF). [9][10][11][12][13][14][15][16][17][18] Although the clinical benefits of CDR have been well-established in literature, the use of this technique in patients with nonlordotic cervical sagittal alignment is not well-established.…”

Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis

“…Therefore, to decrease the risk of ASD in cervical surgery, cervical disc arthroplasty (CDA) was introduced as an alternative treatment for cervical disc degenerative diseases (CDDDs) in the past 20 years [5]. With a mobile device between two contiguous vertebrae, the mobility of operated segments can be preserved, which may potentially decrease the incidence of ASD postoperatively [6]. Moreover, CDA was reported to show better improvement in clinical functions than fusion surgery because the normal kinematics of the involved segments are maintained [7].…”

Comparison of the safety of outpatient cervical disc replacement with inpatient cervical disc replacement

“…The number of outpatient CDR procedures shows an increasing trend in recent years. [ 19 ] Several studies have reported the noninferiority of outpatient CDR compared with outpatient ACDF or inpatient CDR. [ 19 – 27 ] However, the generalizability of these studies is limited by the retrospective study design, small sample size, and low incidence of CDR-associated complications.…”