Outpatient Anterior Cervical Discectomy and Fusion: An Analysis of Readmissions from the New Jersey State Ambulatory Services Database

Abstract

Background Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology. Few reports have attempted to assess readmissions following outpatient ACDF. This study was performed to address this issue using population-based databases. Methods The State Ambulatory Services Database (SASD) for New Jersey (NJ) from 2003-2012 was used for analysis. Patients receiving ACDF (defined as anterior cervical fusion (ICD-0 code=81.02) + excision of intervertebral disc (80.51)) were extracted; those with three or more levels fused (ICD-9 codes 81.63-81.64), cancer (ICD-9 codes 140-239), or trauma (ICD-9 codes=805.0-806.9) were excluded. A series of perioperative complications including durotomy, red blood cell transfusion, acute posthemorrhagic anemia, paraplegia (weakness), and mortality were examined. Propensity score matching (PSM) was used to adjust the analysis for patient age, race, sex, primary payer for care, and number of diagnoses. The NJ SASD defined readmission as admission to the same facility within seven days of initial discharge. Results Two thousand sixteen (2,016) patients were found, 1,528 of whom had readmission data. Of these 1,528 patients, 83 (5.4%) required readmission. PSM was performed prior to comparing readmission versus non-readmission. While there was no difference in perioperative complications between the two groups, the small sample size of the readmission cohort prevented this analysis from having sufficient power. No patient requiring readmission had an initial length of stay greater than one day. Conclusion Based on a 10-year outpatient analysis, fewer than 6% of outpatient 1-2 level ACDFs require readmission. Future studies involving outpatients from several states will be necessary to determine whether these results of outpatient ACDF are applicable nationwide. complications keywords: anterior cervical discectomy and fusion, outpatient, readmission, new jersey state ambulatory and services database volume 11 issue 1

Comparison of Multilevel Anterior Cervical Discectomy and Fusion Performed in an Inpatient Versus Outpatient Setting

“…This finding is not surprising, given that age is a known risk factor for peri-complications in spine surgery 25,33 and the presence of comorbidities may increase the risk anesthetic or other perioperative complications, and thus these patients are likely to be selected for inpatient procedures to allow for prolonged monitoring. Although these studies included 1- and 2- level cases in contrast to our study, which included 2- and 3- level cases, the findings of our study are consistent with the results reported by McGirt et al, 30 Fu et al, 31 and McClelland et al, 23,32 which showed that ACDF can be safely performed in the outpatient setting, with no increase in complication rates in appropriately selected patients. In contrast, Arshi et al 25 found a greater risk of perioperative complications, including the need for revision surgeries, as well as a higher risk of postoperative acute renal failure in the outpatient setting; the reason for this concerning finding is unclear.…”

“…The few studies that include outpatient multilevel fusions also include 1-level fusions, which account for a majority of the study population. 3,23 -32…”

Low Complication Rate of Anterior Lumbar Spine Surgery in an Ambulatory Surgery Center

“…As the cost of healthcare has been rising rapidly within the United States, an attempt is being made to perform an increasing proportion of spine surgery procedures in ambulatory surgery centers (ASCs). ASCs are more efficient than large hospitals, both economically and functionally, with reports of high rates of safety, economic efficiency, and patient satisfaction for outpatient anterior cervical discectomy and fusion, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] posterior cervical foraminotomy, 15,16 cervical total disc replacement, 17,18 posterior lumbar laminectomy or discectomy, [19][20][21][22][23][24][25] posterior lumbar fusion (minimally invasive transforaminal lumbar interbody fu-sion), 26,27 and lumbar direct lateral interbody fusions. 28,29 There has been uncertainty regarding the safety of performing anterior lumbar procedures requiring vascular access, as to date little has been published on this subset of patients.…”

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

“…The surgical approach for anterior cervical spinal fusion itself involves little disruption of local musculatures or other systemic intervention. Although general anesthesia and hospitalization is usually required for patients who undergo ACDF surgery, efforts have been made by experts in spine care to expedite the treatment algorithm and reduce the length of stay needed for ACDF [15,16]. In the United States, many ACDF operations are performed in ambulatory care settings, and patients can go home the same day after surgery [11,17,18].…”