Safety and Efficiency of Cervical Disc Arthroplasty in Ambulatory Surgery Centers vs. Hospital Settings

Abstract

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

Comparison of the Safety of Outpatient Cervical Disc Replacement With Inpatient Cervical Disc Replacement: A Systematic Review and Meta-Analysis

“…Cuellar et al 19 also reported 1 case of intractable nausea. Gornet et al 16 reported 8 adverse events, but only wound dehiscence was shown in their article. Dysphagia was reported by Chin et al 17…”

“…Patients could be divided into either the outpatient group or the inpatient group depending on the definition of the study. For example, some patient may stay overnight in the hospital for postoperative monitoring if their surgeries were scheduled for later in the day, and they were still divided into the outpatient group in the study by Gornet et al, 16 but could be classified into the inpatient group according to the definition of Bovonratwet et al 15 Although the above factors could affect the accuracy of the results, our study showed that the pooled prevalence of overall complication for outpatient CDR was very low (0.51%; 95% CI 0.10% to 1.13%). With proper patient selection, CDR can be performed safely in outpatient settings.…”

“…Patients could be divided into either the outpatient group or the inpatient group depending on the definition of the study. For example, some patient may stay overnight in the hospital for postoperative monitoring if their surgeries were scheduled for later in the day, and they were still divided into the outpatient group in the study by Gornet et al, 16 but could be classified into the inpatient group according to the definition of Bovonratwet et al 15…”

“…Bovonratwet et al 15 reported 1 patient who underwent secondary surgery due to cervical disc displacement (ICD-9: 722.0). Gornet et al 16 reported 3 patients who underwent additional operation of the cervical spine during the 90-day period postoperation.…”

“…1,13 Several studies have reported the efficacy and safety of outpatient CDR. 11 -19 However, the generalizability of these studies is limited by the small sample size and lack of control groups. Therefore, the safety profile surrounding outpatient CDR remains insufficient.…”