No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or Multiple-level Cervical Disk Replacement for Cervical Radiculopathy

Abstract

Study Design. Retrospective cohort analysis. Objective. To investigate the safety profile of outpatient versus inpatient single-level and multiple-level cervical disk replacement (CDR) by analyzing one-and two-year surgical outcomes and 90-day medical complications using a large patient database. Summary of Background Data. CDR is becoming a more desirable option for patients undergoing cervical spine procedures. Unlike anterior cervical diskectomy and fusion, CDR is motionpreserving and has been shown to reduce rates of adjacent segment disease. Current literature investigating outpatient versus inpatient CDR has shown a similar safety profile among the two cohorts. However, most of these studies have relatively small sample sizes with short-term follow-up. Materials and Methods. A retrospective cohort study was done using the PearlDiver patient database between 2010 and 2019. Patients who underwent single-level and multiple-level CDR with a follow-up of at least two years were identified. Patients within each procedure cohort were subdivided into an outpatient and an inpatient group. Univariate and multivariable analyses were performed. Results. In total, 2294 patients underwent single-level CDR of which 506 patients underwent outpatient CDR and 1788 underwent inpatient CDR. In total, 236 patients underwent multiple-level CDR of which 49 patients underwent outpatient CDR and 187 underwent inpatient CDR. In the single-level CDR cohort, patients undergoing outpatient CDR were found to have lesser odds of a decompressive laminectomy at one year following the initial procedure (odds ratio = 0.471; 95% confidence interval. 0.205-0.945; P = 0.05). No significant differences in one-and two-year surgical complications, or 90-day postoperative complications, were found on multivariate analysis of outpatient versus inpatient multiple-level CDR. Conclusion. Our study found that performing single-level and multiple-level CDR on an outpatient basis has a similar safety profile to patients who underwent these procedures in an inpatient setting.

Presentation and management of infection in total disc replacement: A review

“…Some database trend studies also explored whether certain factors were associated with TDR infection. No significant difference was found between inpatient and outpatient procedures (for lumbar TDR at 30 days [ 27 , 33 ] and cervical TDR 90 days [19] ) or between cervical TDR patients with and without myelopathy [26] . The impacts of infections were also noted; Ansari et al reported an association between SSI and the likelihood of reoperation, and Zeidan et al found that wound infection complications were predictors of patient readmission and extended length of stay.…”

“…For 90-day follow-up, lumbar TDR wound infection and periprosthetic infection were reportedly up to 0.25% and 0.04%, respectively [32] . For cervical TDR, Kelly et al reported a 90-day wound infection rate of 0.14% [20] and Ifarraguerri et al reported SSI rates up to 0.8% [19] . Only one study included longer follow-up for infection outcomes and reported a cervical TDR SSI rate of 0.99% for 6 months and 1.38% at one year [23] .…”