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

Wang, Xiaofei; Meng, Yang; Líu, Hao; Hong, Ying; Wang, Beiyu; Ding, Chen; Yang, Yi

doi:10.1177/2192568220959265

Cited by 6 publications

(7 citation statements)

References 28 publications

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“…CDR has been associated with significantly improved short-term neurological outcomes, preserved range of motion, and decreased complications in comparison with traditional ACDF 4,16 . Further, CDR has increasingly been performed in the ambulatory setting, without significant risk of hospital admission or readmission 17,18 …”

Section: Discussionmentioning

confidence: 99%

“…4,16 Further, CDR has increasingly been performed in the ambulatory setting, without significant risk of hospital admission or readmission. 17,18 PROMs PROMIS-PF and SF-12 PCS represent patient surveys that measure physical function. 19,20 Both cohorts were associated with improved physical function from preoperative baseline for PROMIS-PF, apart from 6-week postoperative follow-up in the non-depressed cohort, and SF-12 PCS, except for 1-year follow-up in the depressed cohort.…”

Section: Demographics and Perioperative Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

Nie

Hartman

Zheng

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective cohort study. Objective: We aim to examine the effects of preoperative mental health status on demographic, perioperative characteristics, and postoperative outcomes in patients undergoing cervical disc replacement (CDR). Summary of Background Data: The effect of preoperative mental health status has not been widely studied in CDR. Methods: Patients undergoing primary CDR were retrospectively collected and stratified into 2 cohorts by 12-item Short Form Survey Mental Composite Score (SF-12 MCS) ≥48.9. Patients without preoperative SF-12 MCS scores or diagnosis of infection, malignancy, or trauma were excluded. Demographic information, perioperative characteristic, and patient reported outcome measures (PROMs) were collected. Patient reported outcome measurement information system physical function (PROMIS-PF)/SF-12 Physical Component Score (PCS)/SF-12 MCS/visual analog scale (VAS) neck/VAS leg/neck disability index (NDI) were collected preoperatively and 6 weeks/12 weeks/6 months/1 year postoperatively. Results: Eighty-seven patients were included, (47 having SF-12 MCS≥48.9). For PROMs, both cohorts had significant improvement from preoperative baseline, besides SF-12 PCS/MCS at 1 year for the depressed cohort and SF-12 MCS at all time points. The non-depressed cohort demonstrated significantly higher PROMIS-PF preoperatively and at 12 weeks, SF-12 PCS at 12 weeks, SF-12 MCS at all time points, decreased VAS neck at 12 weeks and NDI preoperatively and at 12 weeks, overall minimal clinically important difference (MCID) in most patients in all PROMs besides SF-12 MCS, and higher MCID for PROMIS-PF at 12 weeks. The depressed cohort demonstrated overall MCID in most patients with PROMIS-PF/SF-12 MCS/VAS neck/NDI, and a higher MCID for 6 weeks/12 weeks/6 months postoperatively and overall SF-12 PCS. Conclusion: Whereas both cohorts demonstrated significantly improved PROMs from baseline, the non-depressed cohort demonstrated better physical function, mental health, decreased pain, and disability at various time points, whereas the depressed cohort demonstrated higher mental health MCID achievement at every time point except 1 year. These findings may be useful in managing expectations for patients undergoing cervical surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Demographics and Perioperative Outcomesmentioning

confidence: 99%

Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

Nie

Hartman

Zheng

et al. 2023

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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“…Previous reviews on outcomes following inpatient versus outpatient surgery have pointed to agenda-driven bias, which may impact what gets reported in the literature. 11 Our study is not immune to this limitation.…”

Section: Literature Reviewmentioning

confidence: 85%

“…[7][8][9][10] The outcomes from these outpatient cervical spine and lumbar decompression surgeries have been extensively studied. [11][12][13][14] Much less studied is outpatient lumbar fusion. 15 Between the years 2004 and 2019, elective lumbar fusion increased by 62.3% in volume, and associated hospital costs have increased by 177%.…”

mentioning

confidence: 99%

Comparison of the Safety of Inpatient Versus Outpatient Lumbar Fusion

Subramanian,

Akosman,

Amen

et al. 2023

Spine

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Study Design. Systematic Review and Meta-Analysis Objective. The objective of this study is to synthesize the early data regarding and analyze the safety profile of outpatient lumbar fusion. Summary of Background Data. Preforming lumbar fusion in an outpatient or ambulatory setting is becoming an increasingly employed strategy to provide effective value-based care. As this is an emerging option for surgeons to employ in their practices, the data is still in its infancy. Methods. This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that described outcomes of inpatient and outpatient lumbar fusion cohorts were searched from PubMed, Medline, The Cochrane Library, and Embase. Rates of individual medical and surgical complications, readmission, and reoperation were collected when applicable. Patient reported outcomes were additionally collected if reported. Individual pooled comparative meta-analysis was performed for outcomes of medical complications, surgical complications, readmission, and reoperation. Patient reported outcomes were reviewed and qualitatively reported. Results. The search yielded 14 publications that compared outpatient and inpatient cohorts with a total of 75,627 patients. Odds of readmission demonstrated no significant difference between outpatient and inpatient cohorts (OR=0.94 [0.81 - 1.11]). Revision surgery similarly was no different between the cohorts (OR=0.81 [0.57 - 1.15]). Pooled medical and surgical complications demonstrated significantly decreased odds for outpatient cohorts compared to inpatient cohorts (OR=0.58 [0.34 - 0.50], OR=0.41 [0.50 - 0.68] respectively). Patient reported outcome measures were largely the same between the cohorts when reported, with few studies showing better ODI and VAS-Leg outcomes among outpatient cohorts compared to inpatient cohorts. Conclusion. Preliminary data regarding the safety of outpatient lumbar fusion demonstrates a favorable safety profile in appropriately selected patients, with patient reported outcomes remaining comparable in this setting. There is no data in the form of prospective and randomized trials which is necessary to definitively change practice.

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“…20 With a growing repertoire of studies reporting the safety and efficacy of conducting CDR at an ASC with appropriate patient selection, additional study is necessary to understand which patients may continue to suffer inferior long-term outcomes despite these advancements in care. [21][22][23] With this in mind, the goal of this study was to evaluate the potential effect of WC status on PROs of physical function, pain, and disability in patients undergoing CDR at an ASC.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Workers' Compensation Status on Patient-Reported Outcomes after Cervical Disc Arthroplasty at an Ambulatory Surgical Center

Hartman

Nie

Zheng

et al. 2023

J Am Acad Orthop Surg

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Introduction: Workers' compensation (WC) status tends to negatively affect patient outcomes in spine surgery. This study aims to evaluate the potential effect of WC status on patient-reported outcomes (PROs) after cervical disc arthroplasty (CDR) at an ambulatory surgical center (ASC). Methods: A single-surgeon registry was retrospectively reviewed for patients who had undergone elective CDR at an ASC. Patients with missing insurance data were excluded. Propensity score-matched cohorts were generated by the presence or lack of WC status. PROs were collected preoperatively and at 6-week, 12-week, 6-month, and 1-year time points. PROs included the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) neck and arm pain, and Neck Disability Index. PROs were compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. Results: Sixty-three patients were included, with 36 without WC (non-WC) and 27 with WC. The non-WC cohort demonstrated postoperative improvement in all PROs at all time points, with the exception of VAS arm past the 12-week point (P ≤ 0.030, all). The WC cohort demonstrated postoperative improvement in VAS neck at 12-week, 6-month, and 1-year time points (P ≤ 0.025, all). The WC cohort improved in VAS arm and Neck Disability Index at the 12-week and 1-year points as well (P ≤ 0.029, all). The non-WC cohort reported superior PRO scores in every PRO at one or more postoperative time points (P ≤ 0.046, all). The non-WC cohort demonstrated higher rates of minimum clinically important difference achievement in PROMIS-PF at 12 weeks (P ≤ 0.024). Conclusion: Patients with WC status undergoing CDR at an ASC may report inferior pain, function, and disability outcomes compared with those with private or government-provided insurance. Perceived inferior disability in WC patients persisted into the long-term follow-up period (1 year). These findings may aid surgeons in setting realistic preoperative expectations with patients at risk of inferior outcomes.

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

Cited by 6 publications

References 28 publications

Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

Comparison of the Safety of Inpatient Versus Outpatient Lumbar Fusion

The Influence of Workers' Compensation Status on Patient-Reported Outcomes after Cervical Disc Arthroplasty at an Ambulatory Surgical Center

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