Retrospective single-centre series of 1300 consecutive cases of outpatient cervical spine surgery: complications, hospital readmissions, and reoperations

Helseth, Øystein; Lied, Bjarne; Heskestad, Ben; Ekseth, K.; Helseth, Eirik

doi:10.1080/02688697.2019.1675587

Cited by 14 publications

(19 citation statements)

References 37 publications

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“…Several studies have shown equal or decreased complication rates in various ambulatory cervical spine procedures, including anterior cervical discectomy and fusion 10,18,29 and posterior cervical decompression. 8,30 However, it is worth noting that the aforementioned studies are not without limitations. Mesregah et al 8 used the retrospective PearlDiver insurance database to examine perioperative complication rates in ambulatory compared with inpatient PCF.…”

Section: Discussionmentioning

confidence: 99%

233. Ambulatory single-level posterior cervical foraminotomy for cervical radiculopathy: a propensity matched analysis of complication rates

et al. 2021

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Section: Discussionmentioning

confidence: 99%

233. Ambulatory single-level posterior cervical foraminotomy for cervical radiculopathy: a propensity matched analysis of complication rates

et al. 2021

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“…In anterior cervical surgery, the balance adjustment of the spine sagittal position is also an indispensable step. erefore, it is clinically guiding significance to explore the changes of sagittal parameters in patients with cervical anterior surgery [15]. e PLP-3DR was established in this study by applying rotation transformation and perspective projection transformation.…”

Section: Discussionmentioning

confidence: 99%

Intelligent Three-Dimensional Reconstruction Algorithm-Based X-Ray Film for Analysis of the Changes in Sagittal Parameters and Curative Effect of Anterior Cervical Surgery

Liu

Zhang

Wang

et al. 2021

Scientific Programming

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In this paper, the change characteristics of sagittal parameters of the patient’s body before and after anterior cervical surgery and rehabilitation effect were analyzed. The rotation transformation and perspective projection transformation were applied to construct a positive and lateral position (PLP) matching-based three-dimensional reconstruction (PLP-3DR) algorithm, which was compared with the marching cubes (MC) algorithm and gravity point (GP) algorithm. PLP-3DR was adopted in X-ray image diagnosis of 124 cervical spondylosis patients. Results showed that sensitivity, specificity, and accuracy of PLP-3DR were markedly higher than those of MC and GP ( P < 0.05 ). The postoperative C2-7 Cobbs’s angle (C2-7Cobb) (11.27 ± 8.41°) was smaller than that before the surgery (15.03 ± 7.39°) ( P < 0.05 ), while the postoperative cervical sagittal vertical axis (cSVA) (21.33 ± 10.38 mm) and Japanese Orthopaedic Association (JOA) scores (16.95 ± 6.07 points) were greater than those before the surgery (14.66 ± 9.68 mm and 11.39 ± 4.28 points) ( P < 0.05 ). Besides, the improvement rate of patients from the cSVA >25 mm group (68.31%) was greater than the rate of the cSVA <15 mm group (45.88%) and the cSVA within 15–25 mm group (47.29%) ( P < 0.05 ). In conclusion, PLP-3DR could effectively improve the diagnostic effect of spine X-ray film images, with high sensitivity and specificity. Anterior cervical surgery had a good curative effect for patients with cervical spondylosis and was closely related to cervical parameters (cSVA, T1 slope, and C2-7Cobb). In addition, patients with cSVA>25 mm could have the best postoperative rehabilitation effect.

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“…Multiple studies documented that major postoperative complications following cervical surgery were “picked up” in PACU “observation windows” that respectively ranged from 4 to 6 h for OSD, and up to 23 h for ASC [ Table 1 ]. [ 1 , 4 - 7 , 9 , 13 - 15 ] Fountas et al . study provided a baseline of 19.3% postoperative AE observed for 1015 inpatients undergoing ACDF.…”

Section: Major Postoperative Adverse Events (Ae) Following Cervical Surgery “Picked Up” Within Postoperative Care Unit (Pacu) “Observatiomentioning

confidence: 99%

“…[ 8 ] All 16 (1.2%) major complications (AE) were diagnosed in the 1300 patients in Helseth et al . (2019) study for patients undergoing cervical surgery, and observed in the OSD PACU for 6 postoperative h.[ 9 ] These AE included; 4 new neurological deficits, 2 hematomas (both readmitted to the hospital), 1 dural tear, 1 surgical site infection, 3 instances of hoarseness, and 5 cases of dysphagia. Similarly, all 10 (0.5%) major complications were also recognized in McGirt (2020) et al .…”

Section: Major Postoperative Adverse Events (Ae) Following Cervical Surgery “Picked Up” Within Postoperative Care Unit (Pacu) “Observatiomentioning

confidence: 99%

“…[ 6 ] Six other clinical series involving cervical surgery performed in OSD/ASC documented 0% mortality rates [ Table 1 ]. [ 1 , 7 - 9 , 13 , 14 ] These latter studies involved a total of 5071 patients, with between 30 and 2000 patients/study; most patients underwent 1–2 level ACDF, with fewer having 3–4 level ACDF, or CDA.…”

Section: % Mortality Rates Reported For Osd/ Asc (4–6–10 H) and Asc (23 H) Cervical Surgerymentioning

confidence: 99%

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Perspective on morbidity and mortality of cervical surgery performed in outpatient/same day/ambulatory surgicenters versus inpatient facilities

Epstein¹

2021

Surgical Neurology International

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Background: This is an updated analysis of the morbidity and mortality of cervical surgery performed in outpatient/same day (OSD) (Postoperative care unit [PACU] observation 4–6 h), and ambulatory surgicenters (ASC: PACU 23 h) versus inpatient facilities (IF). Methods: We analyzed 19 predominantly level III (retrospective) and IV (case series) studies regarding the morbidity/mortality of cervical surgery performed in OSC/ASC versus IF. Results: A “selection bias” clearly favored operating on younger/healthier patients to undergo cervical surgery in OSD/ASC centers resulting in better outcomes. Alternatively, those selected for cervical procedures to be performed in IF classically demonstrated multiple major comorbidities (i.e. advanced age, diabetes, high body mass index, severe myelopathy, smoking, 3–4 level disease, and other comorbidities) and had poorer outcomes. Further, within the typical 4–6 h. PACU “observation window,” OSD facilities “picked up” most major postoperative complications, and typically showed 0% mortality rates. Nevertheless, the author’s review of 2 wrongful death suits (i.e. prior to 2018) arising from OSD ACDF cervical surgery demonstrated that there are probably many more mortalities occurring following discharges from OSD where cervical operations are being performed that are going underreported/unreported. Conclusion: “Selection bias” favors choosing younger/healthier patients to undergoing cervical surgery in OSD/ ASC facilities resulting in better outcomes. Atlernatively, choosing older patients with greater comorbidities for IF surgery correlated with poorer results. Although most OSD cervical series report 0% mortality rates, a review of 2 wrongful death suits by just one neurosurgeon prior to 2018 showed there are probably many more mortalities resulting from OSD cervical surgery than have been reported.

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Retrospective single-centre series of 1300 consecutive cases of outpatient cervical spine surgery: complications, hospital readmissions, and reoperations

Cited by 14 publications

References 37 publications

233. Ambulatory single-level posterior cervical foraminotomy for cervical radiculopathy: a propensity matched analysis of complication rates

233. Ambulatory single-level posterior cervical foraminotomy for cervical radiculopathy: a propensity matched analysis of complication rates

Intelligent Three-Dimensional Reconstruction Algorithm-Based X-Ray Film for Analysis of the Changes in Sagittal Parameters and Curative Effect of Anterior Cervical Surgery

Perspective on morbidity and mortality of cervical surgery performed in outpatient/same day/ambulatory surgicenters versus inpatient facilities

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