Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults

Abstract

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.

Effects of Body Mass Index on Perioperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery

“…We are not certain why obese patients would experience less hardware malfunction however it may be secondary to the fact that they are less likely to develop osteopenia/osteoporosis or perhaps, it is because nonobese patients are quicker to mobilize, leaving them more susceptible to hardware malfunction. Other large database studies identified younger age, being male, and suffering psychiatric disorders as independent risk factors for reoperations [ 37 ] and patients discharged early had higher readmission rates, especially amongst older adults [ 38 ].…”

Early Discharged Lumbar Spine Fusion Reduced Postoperative Readmissions: A Retrospective Cohort Study

“…Also, the patients who agreed to be discharged earlier in the postoperative course of their disease might simply have less concerns for their health than others and may therefore have an overall lower readmission rate. It is reasonable to infer that ED is an effective management strategy in certain subgroups, while for others it may not be [25]. Therefore, even though the current study demonstrated benefits of ED, more investigation focusing on different subgroups and pooling more observational studies from other sites are necessary to corroborate this.…”

Previous Emergency Department Admission Is Associated With Increased 90-Day Readmission Following Cervical Spine Surgery

“…Presently, enhanced recovery after surgery principles are being applied as surgical management efforts for cervical spinal fusion and have been shown to reduce in-hospital patient length of stay and 90-day complication rates, but readmission rates and 3-month patient-reported outcomes continue to be comparable between patients who have enhanced recovery after surgery implemented in their care and those that do not 24. Further, in regards to patient management after cervical fusion surgery, early discharge of patients has been shown to increase patient risk for readmission 25. Beyond this, the literature regarding the management of cervical spine fusion to reduce patient readmission is lacking.…”

“…24 Further, in regards to patient management after cervical fusion surgery, early discharge of patients has been shown to increase patient risk for readmission. 25 Beyond this, the literature regarding the management of cervical spine fusion to reduce patient readmission is lacking.…”