Outpatient and Inpatient Single-level Cervical Total Disc Replacement

Segal, Dale N; Wilson, Jacob M.; Staley, Christopher; Yoon, Sung-Hoon

doi:10.1097/brs.0000000000002739

Cited by 32 publications

(47 citation statements)

References 23 publications

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“…Infection was also present in <3.7% of patients within 3 months after CDR. This result is consistent with prior studies in the literature that documented infection rates ranging from 0% to 2.9% [8,26,[28][29][30]. Lastly, reoperation or revision within 1 year after CDR occurred in <3.7% of patients.…”

Section: Discussionsupporting

confidence: 92%

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Cervical Disc Replacement: Trends, Costs, and Complications

et al. 2020

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To investigate national trends, complications, and costs after cervical disc replacement (CDR) using an administrative insurance database representative of the United States population. Overview of Literature: As CDR continues to be used to treat patients with cervical stenosis, it is important to gain a better understanding of its use on a national level, potential complications, and cost. This information will allow for optimal patient counseling, risk stratification, and healthcare cost assessments. Several prior studies have investigated complications associated with CDR, but they have been limited by small sample size, single institution experiences, limited follow-up, and potential conflicts of interest. Methods: Patients who underwent single or multilevel CDR between 2007 and 2015 were identified using an insurance database. We collected data on annual trends, reimbursement costs, patient demographic information, hospital information, and information on complications from the time of operation to 1 year postoperative. Results: Total of 293 patients underwent either single or multilevel CDR. The number of procedures increased nonlinearly over time at an average of 17% per year, with a greater increase seen in the outpatient setting. Less than 3.7% of patients had new onset pain within 1 year after CDR. Within 1 year, 12.3% of patients reported a mechanical and/or bone-related complication. There were no patients who indicated a new nerve injury within 6 months of follow-up. Less than 3.7% of patients presented with dysphagia or dysphonia within 6 months, infection within 3 months, or a revision or reoperation within 1 year. Average reimbursement for single-level inpatient versus outpatient CDR was $33,696.28 and $34,675.12, respectively (p=0.29). Conclusions: This study demonstrated that the use of CDR continued to increase. The most common complication was mechanical and/or bone-related, and cost analysis demonstrated no significant difference between inpatient and outpatient CDR.

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Section: Discussionsupporting

confidence: 92%

“…Lastly, reoperation or revision within 1 year after CDR occurred in <3.7% of patients. Other large database studies have demonstrated similarly low reoperation rates of <1%, though these studies only assessed revisions within 30 days [30].…”

Section: Discussionmentioning

confidence: 95%

Cervical Disc Replacement: Trends, Costs, and Complications

et al. 2020

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“…The above factors were also individually analyzed for association with the primary outcomes using univariate logistic regression. Potential predictor variables from the univariate analyses that were either significant ( P < .05) or trended toward significance ( P < .10), 14 as well as surgical setting, were then evaluated for significance ( P < .05) as independent predictors and control variables in a series of multivariate logistic regression analyses of the primary outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…Low complication rates for outpatient discectomy have been well described. [27][28][29][30] Moreover, Segal et al 14 demonstrated no significant difference in rates of readmission, reoperation, or complication when comparing inpatient to outpatient cervical disc replacement.…”

Section: Comparison Of Setting: Primary Outcomesmentioning

confidence: 99%

“…4,[10][11][12] Spine surgery in general has been increasingly performed in the outpatient setting. [4][5][6][7][13][14][15][16] In the appropriate patient population, outpatient spine surgery offers greater control over cost, efficiency, and productivity, all of which are necessary to keep up with the demands of an aging population and a changing health care payment and delivery landscape. 7,14,15,17 However, short-term outcomes-research evaluating the safety of this trend is limited, particularly with regard to LDA.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of 30-Day Readmission, Reoperation, and Morbidity Between Lumbar Disc Arthroplasty Performed in the Inpatient and Outpatient Settings Utilizing the ACS-NSQIP Dataset

Katz

Perfetti

Job

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: Spine surgery has been increasingly performed in the outpatient setting, providing greater control over cost, efficiency, and resource utilization. However, research evaluating the safety of this trend is limited. The objective of this study is to compare 30-day readmission, reoperation, and morbidity for patients undergoing lumbar disc arthroplasty (LDA) in the inpatient versus outpatient settings. Methods: Patients who underwent LDA from 2005 to 2018 were identified using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Regression was utilized to compare readmission, reoperation, and morbidity between surgical settings, and to evaluate for predictors thereof. Results: We identified 751 patients. There were no significant differences between inpatient and outpatient LDA in rates of readmission, reoperation, or morbidity on univariate or multivariate analyses. There were also no significant differences in rates of specific complications. Inpatient operative time (138 ± 75 minutes) was significantly ( P < .001) longer than outpatient operative time (106 ± 43 minutes). In multivariate analysis, diabetes ( P < .001, OR = 7.365), baseline dyspnea ( P = .039, OR = 6.447), and increased platelet count ( P = .048, OR = 1.007) predicted readmission. Diabetes ( P = .016, OR = 6.533) and baseline dyspnea ( P = .046, OR = 13.814) predicted reoperation. Baseline dyspnea ( P = .021, OR = 8.188) and ASA (American Society of Anesthesiologists) class ≥3 ( P = .014, OR = 3.515) predicted morbidity. Decreased hematocrit ( P = .008) and increased operative time ( P = .003) were associated with morbidity in univariate analysis, but not in multivariate analysis. Conclusions: Readmission, reoperation, and morbidity were statistically similar between surgical setting, indicating that LDA can be safely performed in the outpatient setting. Higher ASA class and specific comorbidities predicted poorer 30-day outcomes. These findings can guide choice of surgical setting given specific patient factors.

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