Current trends in ambulatory spine surgery: a systematic review

DelSole, Edward M.; Makanji, Heeren S.; Kurd, Mark F.

doi:10.21037/jss.2019.04.12

Cited by 23 publications

(28 citation statements)

References 38 publications

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“…13,[15][16][17][18]20,21,32,33 A systematic review of 56 articles evaluating ambulatory spine surgery found that a majority of studies reported no differences in peri-and postoperative complications, readmissions, and reoperations when compared to inpatient cases. 19,33,34 These findings indicate that outpatient spine cases may be a safe alternative to the traditional inpatient cases. Furthermore, a metaanalysis of studies evaluating cervical and lumbar spine surgeries, with a total of 370,195 patients, demonstrated that outpatient procedures had significantly lower overall costs when compared to inpatient procedures.…”

Section: Discussionmentioning

confidence: 92%

“…Similarly, there has been a trend toward outpatient spinal procedures, many of which show it to be a feasible option to offset hospital costs without compromising patient safety. [19][20][21][22] There is generally an inherently higher risk profile in patients undergoing spinal procedures when compared to other divisions of orthopedic surgeries. 23 Although there has been much research comparing the safety and efficacy of inpatient versus outpatient spinal procedures, there is very limited (if any) literature comparing the outcomes of this transition to additional orthopedic procedures.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

et al. 2021

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Background: Spinal surgery is associated with an inherently elevated risk profile, and thus far there has been limited discussion about how these outpatient spine patients are benefiting from these same-day procedures against other typical outpatient orthopedic surgeries.Methods: Orthopedic patients who received either inpatient or outpatient surgery were isolated in the American College of Surgeons National Surgical Quality of Improvement Program (2005Program ( -2016. Patients were stratified by type of orthopedic surgery received (spine, knee, ankle, shoulder, or hip). Mean comparisons and chi-squared tests assessed basic demographics. Perioperative complications were analyzed via regression analyses in regard to their principal inpatient or outpatient orthopedic surgery received.Results: This study included 729 480 surgical patients: 32.5% received spinal surgery, 36.5% knee, 24.1% hip, 4.9% shoulder, and 1.7%ankle. Of those who received a spinal procedure, 74.7% were inpatients (IN), and 25.3% were outpatients (OUT): knee: 96.1% IN, 3.9% OUT; hip:98.9% IN, 1.1% OUT; ankle: 29% IN, 71% OUT; and shoulder: 52.6% IN, 47.6% OUT. Hip patients were the oldest, and knee patients had the highest body mass index out of the orthopedic groups (P , .00). Spine IN patients experienced more complications than the other orthopedic groups and had the lowest OUT complications(both P , .05). This same trend of having higher IN complications than OUT complications was identified for hip, shoulder, and knee. However, ankle procedures had greater OUT procedure complications than IN (P , .05). After controlling for age, body mass index, and Charlson Comorbidity Index, IN procedures, such as knee, hip, spine, and shoulder, were significantly associated with experiencing postoperative complications. From 2006 to 2016, IN and OUT surgeries were significantly different among complications experienced for all of the orthopedic groups (P , .05) with complications decreasing for IN and OUT patients by 2016.Conclusions: Over the past decade, spine surgery has decreased in complications for IN and OUT procedures along with IN/OUT knee, ankle, hip, and shoulder procedures, reflecting greater tolerance for risk in an outpatient setting.Level of Evidence: 3. Clinical Relevance: Despite the increase in riskier spine procedures, complications have decreased over the years. Surgeons should aim to continue to decrease inpatient spine complications to the level of other orthopedic surgeries.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

et al. 2021

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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%

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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“…As a result, procedures for both the cervical [anterior cervical discectomy and fusion (ACDF)] and lumbar spine [lumbar decompressions, minimally invasive transforaminal, and lateral lumbar interbody fusion (LLIF)] have been performed in ASCs using minimally invasive, open, endoscopic, microsurgical, or combined surgical techniques. 5 However, the combination of both varying techniques and procedure types open the possibility for iatrogenic complications. Risk is typically reduced through the screening of perioperative characteristics such as body mass index and comorbidity scores 6 ; however, even when selection protocols are utilized, postoperative complications can still occur.…”

mentioning

confidence: 99%

“…4,7 Current systematic reviews regarding complication rates in the ASC setting report on different selection criteria, facility type, and both procedure and technique type. 5,8,9 Seldom do reviews focus exclusively on complication rates among spinal procedures, leaving a void of understanding their true prevalence. Therefore, the aim of this systematic review is to determine complication rates among patients undergoing spine surgery in the ambulatory surgical setting.…”

mentioning

confidence: 99%

Spine Surgery Complications in the Ambulatory Surgical Center Setting

Elliot

Lynch

Hrynewycz

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Purpose: This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC).Background: Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates.Methods: This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series ( ≤ 10 patients). The primary outcome was the frequency of complications with respect to various categories.Results: Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/ 1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/ operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092).Conclusions: After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.

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Current trends in ambulatory spine surgery: a systematic review

Cited by 23 publications

References 38 publications

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

Outcomes of Same-Day Orthopedic Surgery: Are Spine Patients More Likely to Have Optimal Immediate Recovery From Outpatient Procedures?

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

Spine Surgery Complications in the Ambulatory Surgical Center Setting

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