Outpatient anterior cervical discectomy and fusion: A meta-analysis

McClelland, Shearwood; Oren, Jon H.; Protopsaltis, Themistocles S.; Passias, Peter G.

doi:10.1016/j.jocn.2016.06.012

Cited by 61 publications

(48 citation statements)

References 15 publications

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“…10,21 However, both physicians and hospital systems have expressed concern about the impact of obesity on the outcomes and costs of spinal procedures. Previous studies have demonstrated that obesity is associated with longer operative times and increased blood loss during spinal surgery.…”

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confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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“…In most studies, for example, patients undergoing revision ACDF or that have pathology spanning 3 or more levels are not candidates for SDD. 1,11,13,15,[16][17][18][19][20]22 Mohandas et al reported best-practice guidelines for outpatient ACDF agreed upon by a multidisciplinary panel. 28 Guidelines that demonstrated 100% consensus included a thorough assessment of thromboembolic risk as well as excluding patients with ASA score 3, which has also been described in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…19 In a meta-analysis by McClelland et al assessing complication and readmission rates in outpatient ACDF, a mean operative time of 90 minutes is reported. 16 An exact amount of time spent monitoring sameday ACDF patients has not been determined; however, mean observation time from 4-8 hours has been reported. 13,16,18,19 For example, Tally et al report average hospital stays of 4.7 and 5.4 hours in single-and 2-level ACDF, respectively, in their retrospective chart review evaluating complication rate of same-day ACDF at an ambulatory surgery center.…”

Section: Discussionmentioning

confidence: 99%

“…16 An exact amount of time spent monitoring sameday ACDF patients has not been determined; however, mean observation time from 4-8 hours has been reported. 13,16,18,19 For example, Tally et al report average hospital stays of 4.7 and 5.4 hours in single-and 2-level ACDF, respectively, in their retrospective chart review evaluating complication rate of same-day ACDF at an ambulatory surgery center. 18 Trahan et al also describe discharge criteria including a minimum of 6 hours of postoperative monitoring, well-controlled pain, as well as the absence of complications including a palpable hematoma or dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Various studies have demonstrated that outpatient ACDF is both safe and effective and has comparable complication, reoperation, readmission, and mortality rates to inpatient ACDF. [13][14][15][16][17][18][19] Some studies have even demonstrated superior outcomes with respect to morbidity and reoperation rates. 1,20 Outpatient surgery is more cost effective, with annual cost savings of up to $140 million on a national level.…”

Section: Introductionmentioning

confidence: 99%

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Same-Day Anterior Cervical Discectomy and Fusion—Our Protocol and Experience: Same-Day Discharge After Anterior Cervical Discectomy and Fusion in Suitable Patients has Similarly Low Readmission Rates as Admitted Patients

et al. 2019

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Background: Outpatient anterior cervical discectomy and fusion (ACDF) is performed frequently, with studies demonstrating similar complication and readmission rates compared to traditional admission. Advantages include cost effectiveness, as well as lower risk of nosocomial infections and medical errors, which lead to quicker recovery and higher patient satisfaction. Protocols are needed to ensure that outpatient ACDF occurs safely. The objective of this study was to develop and implement a protocol with patient selection and discharge criteria for patients undergoing same-day discharge (SDD) ACDF and assess readmission rates. Methods: A retrospective chart review was performed to identify patients undergoing 1 or 2 level primary ACDF between March 2016 and March 2017 who were eligible for SDD according to the institutional protocol (Figure 1, Table 2). Patients with identical surgery and discharge dates were grouped as SDD, and admitted patients were grouped as same-day admission (SDA). Using our electronic health record's analytics, readmissions in the 90-day postoperative period were identified. Results: Of the 434 patients identified, 126 patients were SDD, and 308 were SDA. Baseline characteristics such as age, operative time, and time in the recovery room were significantly different between the 2 groups (Table 2). The average length of stay of admitted patients was 1.48 days, with 77% discharged on postoperative day 1. There was an overall, noninferior readmission rate of 0.8% in the SDD group compared to 0.6% in the SDA group (P ¼ .86). Conclusions: The results of this study support the feasibility of outpatient ACDF and add a patient selection and discharge criteria to the literature. Proper identification of suitable patients using our protocol results in a noninferior readmission rate, allowing surgeons to continue to safely perform these surgeries with a low readmission rate. Level of Evidence: 3. Clinical Relevance: SDD is safe in the appropriate patient population.

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