“…Figure 1 shows the flow diagram that reflects the search process. Among the 12 article, seven [16, 18, 21, 22, 24, 25, 27] were subsumed into the meta-analysis, and the other five [17, 19, 20, 23, 26] were included to present the complications of the outpatient surgery.Fig. 1Flow diagram of the study selection which shows the number of citations identified, excluded and included in final analysis…”
BackgroundAnterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries and neurosurgical procedures performed to treat a variety of disorders in the cervical spine. Over the last several years, ACDF has been done in the outpatient setting for less invasive approaches and exposures, as well as modified anesthetic and pain management techniques. Despite the fact that it may be innocuous in other parts of the body, complications in the spine can literally be fatal. The objective of this article is to evaluate the safety of outpatient surgery compared with inpatient surgery in the cervical spine for adult patients.MethodsThe multiple databases including Pubmed, Springer, EMBASE, EBSCO and China Journal Full-text Database were adopted to search for the relevant studies in English or Chinese. Full-text articles involving to the safety of outpatient cervical spine surgery were selected. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Chi-square tests were conducted with SPSS 20.0 software.ResultsFinally, 12 articles were included. The results of meta-analysis suggested that in the articles included, no death occurred, and compared with inpatient surgery, outpatient surgery has a similar risk (RR = 0.99, 95 % CI [0.98, 1.00], P = 0.02; P for heterogeneity = 0.47, I2 = 0 %). An I2 value of 0 % indicates no heterogeneity observed. All complications were occurred in both outpatients and inpatients. Among the studies selected, after the outpatient spine surgery, the highest incidences of complication were dysphagia (18/29) and hematoma (4/29). Compared with the overall complication rate in inpatient group, no significant difference was observed (x2 = 1.820, P = 0.177).ConclusionIn this study, outpatient surgery has a similar risk with inpatient surgery, and no difference of morbidity between outpatient and inpatient was found. Because of short operative time and moderate postoperative pain, we believe that outpatient cervical spine surgery is a safe and convenient alternative procedure, which also decrease the cost of care. Besides, postoperative complications including dysphagia and hematoma should be noticed.
“…Figure 1 shows the flow diagram that reflects the search process. Among the 12 article, seven [16, 18, 21, 22, 24, 25, 27] were subsumed into the meta-analysis, and the other five [17, 19, 20, 23, 26] were included to present the complications of the outpatient surgery.Fig. 1Flow diagram of the study selection which shows the number of citations identified, excluded and included in final analysis…”
BackgroundAnterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries and neurosurgical procedures performed to treat a variety of disorders in the cervical spine. Over the last several years, ACDF has been done in the outpatient setting for less invasive approaches and exposures, as well as modified anesthetic and pain management techniques. Despite the fact that it may be innocuous in other parts of the body, complications in the spine can literally be fatal. The objective of this article is to evaluate the safety of outpatient surgery compared with inpatient surgery in the cervical spine for adult patients.MethodsThe multiple databases including Pubmed, Springer, EMBASE, EBSCO and China Journal Full-text Database were adopted to search for the relevant studies in English or Chinese. Full-text articles involving to the safety of outpatient cervical spine surgery were selected. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Chi-square tests were conducted with SPSS 20.0 software.ResultsFinally, 12 articles were included. The results of meta-analysis suggested that in the articles included, no death occurred, and compared with inpatient surgery, outpatient surgery has a similar risk (RR = 0.99, 95 % CI [0.98, 1.00], P = 0.02; P for heterogeneity = 0.47, I2 = 0 %). An I2 value of 0 % indicates no heterogeneity observed. All complications were occurred in both outpatients and inpatients. Among the studies selected, after the outpatient spine surgery, the highest incidences of complication were dysphagia (18/29) and hematoma (4/29). Compared with the overall complication rate in inpatient group, no significant difference was observed (x2 = 1.820, P = 0.177).ConclusionIn this study, outpatient surgery has a similar risk with inpatient surgery, and no difference of morbidity between outpatient and inpatient was found. Because of short operative time and moderate postoperative pain, we believe that outpatient cervical spine surgery is a safe and convenient alternative procedure, which also decrease the cost of care. Besides, postoperative complications including dysphagia and hematoma should be noticed.
“…1,4 Surgeons have analyzed spinal surgeries performed in patient cohorts ranging in size from less than 100 to over 1000 patients. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Furthermore, the comparative safety and effectiveness of spine surgery performed on an outpatient versus inpatient basis have been evaluated for a variety of procedures: lumbar discectomy, 21,22 lumbar decompression, 23,24 lumbar interbody fusion, 25,26 anterior cervical discectomy and fusion (ACDF), [27][28][29][30][31][32] and cervical disc arthroplasty (CDA). 33 The complexity of outpatient spine surgeries has also increased from microdiscectomy and decompression, to single-level fusion and multi-level fusion using an anterior approach.…”
Background: Outpatient surgery has been shown safe and effective for anterior cervical discectomy and fusion (ACDF), and more recently, for 1-level cervical disc arthroplasty (CDA). The purpose of this analysis is to compare the safety and efficiency of 1-level and 2-level CDA performed in an ambulatory surgery center (ASC) and in a hospital setting.Methods: The study was a retrospective collection and analysis of data from consecutive CDA patients treated in ASCs compared to a historical control group of patients treated in hospital settings who were classified as outpatient (0 or 1-night stay) or inpatient (2 or more nights). Surgery time, blood loss, return to work, adverse events (AEs), and subsequent surgeries were compared.Results: The sample consisted of 145 ASC patients, 348 hospital outpatients, and 65 hospital inpatients. A greater proportion of 2-level surgeries were performed in hospital than ASC. Surgery times were significantly shorter in ASCs than outpatient or inpatient 1-level (63.6 6 21.6, 86.5 6 35.8, and 116.7 6 48.4 minutes, respectively) and 2-level (92.4 6 37.3, 126.7 6 43.8, and 140.3 6 54.5 minutes, respectively) surgeries. Estimated blood loss was also significantly less in ASC than outpatient and inpatient 1-level (18.5 6 30.6, 43.7 6 35.9, and 85.7 6 98.0 mL, respectively) and 2-level (21.1 6 12.3, 67.8 6 94.9, and 64.9 6 66.1 mL). There were no hospital admissions and no subsequent surgeries among ASC patients. ASC patients had 1 AE (0.7%) and hospital patients had 10 AEs (2.4%). Working patients returned to work after a similar number of days off, but fewer ASC patients had returned to work by the end of the 90-day period.Conclusions: Both 1-and 2-level CDA may be performed safely in an ASC. Surgeries in ASCs are of shorter duration and performed with less blood loss without increased AEs.
Cervical Spine
“…The average operative time was 40 min and the average recovery time prior to discharge was 3 h. A minimum 3-h stay in recovery had been previously instituted for outpatient ACDF cases. [ 5 ]…”
Section: Resultsmentioning
confidence: 99%
“…[ 1 ] Similarly, ambulatory surgery for ACDF has been utilized with increasing frequency and has been demonstrated to be safe and efficacious. [ 5 16 ] The known complications of ACDF surgery[ 6 ] have not been reported to be of any higher frequency in the outpatient setting, and actually are indeed lower. [ 5 ]…”
Section: Introductionmentioning
confidence: 99%
“…[ 5 16 ] The known complications of ACDF surgery[ 6 ] have not been reported to be of any higher frequency in the outpatient setting, and actually are indeed lower. [ 5 ]…”
Background:To assess the safety, clinical efficacy, and cost-effectiveness of outpatient cervical disc arthroplasty.Methods:We retrospectively reviewed the records of 26 consecutive patients who underwent outpatient cervical disc arthroplasty between February 2009 and May 2010 in order to assess the safety, clinical efficacy, and cost-effectiveness of the process. Fourteen patients were operated in a —free-standing practice-based ambulatory spine surgery center (MSC) and 12 patients were operated in a hospital-based outpatient surgery center. The mean age of the patient sample was 46 years; 56% were female and 44% were male. Indications for surgery consisted of cervical radiculopathy secondary to single-level soft disc herniation. Charts were reviewed to define patient demographics and medical comorbidities. Operative data, including levels treated, surgery time, time to discharge, and intraoperative complications were collected. Clinical outcomes were collected using the PhDx Clinical Outcomes Database. Need for hospital transfer from the ambulatory surgical center (ASC), emergency room visits, and subsequent hospital admission in the perioperative period were determined from patient records. Complications, patient satisfaction, and outcome were ascertained via review of notes from the first post-operative visit.Results:There was no mortality and no major complications. Pain was present in 100% and motor deficit in 33% of the patients. There were no co-morbidities reported in the group. There were no cases that required hospital transfer and there were no post-op Emergency Room visits or subsequent hospitalization. At the time of the first post-operative visit, 100% of the patients believed that they were improved and no patient had any post-operative complications. The cost of outpatient single-level cervical disc arthroplasty was 62% less than the outpatient single-level cervical anterior discectomy with fusion using allograft and plate and 84% less than the inpatient single-level cervical disc arthroplasty.Conclusions:Outpatient cervical disc arthroplasty is safe and clinically efficacious in selected patients and is cost-effective compared with both inpatient cervical disc arthroplasty and outpatient anterior discectomy with fusion.
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