Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries

Abstract

OBJECTIVEWith the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).METHODSThis was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.RESULTSAnalysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.CONCLUSIONSThis study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.

Surgical Realignment After Anterior Multilevel Decompression Using Cages and Plate for 3-level to 5-level Degenerative Fusions

“…These results highlight the importance of certain preoperative factors and the influence on surgical planning. Previous studies rather focused purely on clinical outcome or radiologic outcome with simple subgroup analysis without conclusions on preoperative factors 24–29…”

“…Previous studies rather focused purely on clinical outcome or radiologic outcome with simple subgroup analysis without conclusions on preoperative factors. [24][25][26][27][28][29] Reciprocal Alignment Changes Figure 6 highlights the complex cervical geometric interdependencies in ACMS. The graphs in Figure 4 illustrate the natural reciprocal changes according to the FA-change/ CL-change from preoperative to postoperative with a reciprocal change of the C0-2 angle, UIV-/LIV-angles, and C7S/T1S.…”

Outpatient Versus Inpatient Anterior Lumbar Spine Surgery: A Multisite, Comparative Analysis of Patient Safety Measures

“…Several studies have compared ASC anterior cervical fusion or disc replacement with inpatient cohorts. [8][9][10][14][15][16][17][18][19][20] While there are also numerous reports on the safety of ASC posterior, [21][22][23][24][25][26] anterior, 13 and lateral lumbar spinal surgery, 27,28 there are very few ASC inpatient comparison studies for lumbar spine surgery. Emami and colleagues compared inpatient and ASC single-and two-level minimally invasive surgical transforaminal lumbar interbody fusion procedures, reporting similar outcomes with a slightly lower readmission rate for the ASC cohort.…”

“…A retrospective comparison of single-level cervical artificial disc replacement (ADR) performed in ASCs versus inpatient settings revealed no difference in the rates of readmission, reoperation, or complications, 7 while other reports have demonstrated lower readmission rates in the ASC cohort. [8][9][10] The safety of 231 single-and multilevel cervical disc replacements performed in 147 patients in an ASC setting with minimal complications or readmissions was recently reported. 11 The authors are aware of only one study directly comparing the safety of anterior lumbar spine surgery performed in a free-standing ASC setting with an inpatient hospital setting, which reported on 62 patients undergoing a single-level anterior lumbar interbody fusion (ALIF) at L5-S1 in an ASC (n ¼ 29) or hospital (n ¼ 33).…”

Is It Safe to Perform True Outpatient Multilevel ACDFs in a Surgery Center?

“…13 Lastly, cohort studies specifically analyzing outpatient versus inpatient multilevel ACDF tend to have low patient numbers 25-outpatients versus 58-inpatients 16 or a disproportionate number of patients in each group-299 outpatients to 32 inpatientswith significant differences in patient comorbidities and age, making it difficult to make an accurate comparison between heterogeneous groups. 17 Many of these aforementioned studies comparing outpatient with inpatient surgery demonstrate lower complication rates in the outpatient cohort. However, this primarily confirms that the selection criteria used adequately differentiate patients who are less likely to have complications.…”