Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis

Ban, De-Xiang; Liu, Yang; Cao, Taiwei; Feng, Shiqing

doi:10.1186/s40001-016-0229-6

Cited by 37 publications

(23 citation statements)

References 32 publications

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“…Similarly, from their study, Samuel et al 26 concluded that the most common cause of readmission after ACDF was non-surgical site-related issues. Furthermore, Samuel et al 26 and Ban et al 2 stated that pneumonia, dysphagia, and hemorrhage/hematoma are prominent causes of readmission after ACDF, which correlates to the results of our study; we found these conditions to be the next-largest causes of readmission after single-level ACDF (Table 2). Organ-space SSI and a swelling, mass, or lump in the neck were found in equal numbers to be the cause of readmission after single-level CDR (Table 2).…”

Section: Discussionsupporting

confidence: 80%

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Bhashyam

Ramos

Nakhla

et al. 2017

FOC

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OBJECTIVE The goal of this study was to compare 30-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion (ACDF) versus those after cervical disc replacement (CDR). METHODS The authors used the 2013–2014 American College of Surgeons National Surgical Quality Improvement Program database. Included were adult patients who underwent first-time single-level ACDF or CDR for cervical spondylosis or disc herniation. Primary outcome measures were readmission and/or reoperation within 30 days of the original surgery. Logistic regression analysis was used to assess the independent effect of the procedure (ACDF or CDR) on outcome, and results are presented as odds ratios with 95% confidence intervals. RESULTS A total of 6077 patients met the inclusion criteria; 5590 (92.0%) patients underwent single-level ACDF, and 487 (8.0%) patients underwent CDR. The readmission rates were 2.6% for ACDF and 0.4% for CDR (p = 0.003). When stratified according to age groups, only patients between the ages of 41 and 60 years who underwent ACDF had a significantly higher readmission rate than those who underwent CDR (2.5% vs 0.7%, respectively; p = 0.028). After controlling for patient age, sex, body mass index, smoking status, history of chronic obstructive pulmonary disease (COPD), diabetes, hypertension, steroid use, and American Society of Anesthesiologists (ASA) class, patients who underwent CDR were significantly less likely to undergo readmission within 30 days than patients who underwent ACDF (OR 0.23 [95% CI 0.06–0.95]; p = 0.041). Patients with a history of COPD (OR 1.97 [95% CI 1.08–3.57]; p = 0.026) or hypertension (OR 1.62 [95% CI 1.10–2.38]; p = 0.013) and those at ASA Class IV (OR 14.6 [95% CI 1.69–125.75]; p = 0.015) were significantly more likely to require readmission within 30 days. The reoperation rates were 1.2% for ACDF and 0.4% for CDR (p = 0.086), and multivariate analysis revealed that CDR was not associated with lower odds of reoperation (OR 0.60 [95% CI 0.14–2.55]; p = 0.492). However, increasing age was associated with a higher risk (OR 1.02 [95% CI 1.00–1.05]; p = 0.031) of reoperation; a 2% increase in risk per year of age was found. CONCLUSIONS Patients who underwent single-level ACDF had a higher readmission rate than those who underwent single-level CDR in this study. When stratified according to age, this effect was seen only in the 41- to 60-year age group. No significant difference in the 30-day single-level ACDF and single-level CDR reoperation rates was found. Although patients in the ACDF group were older and sicker, other unmeasured covariates might have accounted for the increased rate of readmission in this group, and further investigation is encouraged.

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Section: Discussionsupporting

confidence: 80%

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Bhashyam

Ramos

Nakhla

et al. 2017

FOC

View full text Add to dashboard Cite

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“…17,24,35 Additionally, Ban and colleagues performed a meta-analysis and systematic review, including articles and 1693 treated levels, which revealed an overall complication rate of 1.71% and a risk ratio of 0.99, suggesting no statistical difference between inpatient and outpatient groups. 6 There may be a longer-term negative effect of outpatient ACDF. Arshi et al examined more than 12,000 patients in a private insurance database and reported that outpatient ACDF was associated with higher odds of repeat anterior surgery at 1 year (OR 1.46) as well as a higher likelihood of undergoing posterior surgery at 6 months and 1 year (ORs 1.58 and 1.79, respectively).…”

Section: Anterior Cervical Discectomy and Fusionmentioning

confidence: 99%

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Pendharkar

Shahin

et al. 2018

Neurosurgical Focus

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Spine surgery is a key target for cost reduction within the United States health care system. One possible strategy involves the transition of inpatient surgeries to the ambulatory setting. Lumbar laminectomy with or without discectomy, lumbar fusion, anterior cervical discectomy and fusion, and cervical disc arthroplasty all represent promising candidates for outpatient surgeries in select populations. In this focused review, the authors clarify the different definitions used in studies describing outpatient spine surgery. They also discuss the body of evidence supporting each of these procedures and summarize the proposed cost savings. Finally, they examine several patient- and surgeon-specific considerations to highlight the barriers in translating outpatient spine surgery into actual practice.

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“…Numerous studies have verified the safety of outpatient ACDF surgery. 3,4,6,19,24,28,33,34,36 The procedure performed in an ambulatory setting is not inferior to inpatient surgery in terms of mortality, 30-day emergency department visit rates, 30-day readmission rates, and 30-day reoperation rates and is less costly than inpatient ACDF in terms of actual costs and 90-day bundled charges. 25 Nonetheless, a recent risk-complication analysis of studies on cervical spine surgery performed in ambulatory surgery centers has revealed that at least some of these studies demonstrated an inherent conflict of interest and did not report major morbidity and mortality rates for outpatient procedures in a nonbiased way, which must be considered.…”

Section: Complicationsmentioning

confidence: 99%

Retrospective single-surgeon study of 1123 consecutive cases of anterior cervical discectomy and fusion: a comparison of clinical outcome parameters, complication rates, and costs between outpatient and inpatient surgery groups, with a literature review

Mullins

Pojskić

Boop

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEOutpatient anterior cervical discectomy and fusion (ACDF) is becoming more common and has been reported to offer advantages over inpatient procedures, including reducing nosocomial infections and costs, as well as improving patient satisfaction. The goal of this retrospective study was to evaluate and compare outcome parameters, complication rates, and costs between inpatient and outpatient ACDF cases performed by 1 surgeon at a single institution.METHODSIn a retrospective study, the records of all patients who had undergone first-time ACDF performed by a single surgeon in the period from June 1, 2003, to January 31, 2016, were reviewed. Patients were categorized into 2 groups: those who had undergone ACDF as outpatients in a same-day surgical center and those who had undergone surgery in the hospital with a minimum 1-night stay. Outcomes for all patients were evaluated with respect to the following parameters: age, sex, length of stay, preoperative and postoperative pain (self-reported questionnaires), number of levels fused, fusion, and complications, as well as the presence of risk factors, such as an increased body mass index, smoking, and diabetes mellitus.RESULTSIn total, 1123 patients were operated on, 485 (43%) men and 638 (57%) women, whose mean age was 50 years. The mean follow-up time was 25 months. Overall, 40.5% underwent 1-level surgery, 34.3% 2-level, 21.9% 3-level, and 3.2% 4-level. Only 5 patients had nonunion of vertebrae; thus, the fusion rate was 99.6%. Complications occurred in 40 patients (3.6%), with 9 having significant complications (0.8%). Five hundred sixty patients (49.9%) had same-day surgery, and 563 patients (50.1%) stayed overnight in the hospital. The inpatients were older, were more commonly male, and had a higher rate of diabetes. Smoking status did not influence the length of stay. Both groups had a statistically significant reduction in pain (expressed as a visual analog scale score) postoperatively with no significant difference between the groups. One- and 2-level surgeries were done significantly more often in the outpatient setting (p < 0.001).The complication rate was 4.1% in the outpatient group and 3.0% in the inpatient group; there was no statistically significant difference between the 2 groups (p = 0.339). Significantly more complications occurred with 3- and 4-level surgeries than with 1- and 2-level procedures (p < 0.001, chi-square test). The overall average inpatient cost for commercial insurance carriers was 26% higher than those for outpatient surgery.CONCLUSIONSAnterior cervical discectomy and fusion is safe for patients undergoing 1- or 2-level surgery, with a very significant rate of pain reduction and fusion and a low complication rate in both clinical settings. Outpatient and inpatient groups undergoing 3- or 4-level surgery had an increased risk of complications (compared with those undergoing 1- or 2-level surgery), with a negligible difference between the 2 groups. This finding suggests that these procedures can also be included as standard outpatient surgery. Comparable outcome parameters and the same complication rates between inpatient and outpatient groups support both operative environments.

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Safety of outpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis

Cited by 37 publications

References 32 publications

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Thirty-day readmission and reoperation rates after single-level anterior cervical discectomy and fusion versus those after cervical disc replacement

Outpatient spine surgery: defining the outcomes, value, and barriers to implementation

Retrospective single-surgeon study of 1123 consecutive cases of anterior cervical discectomy and fusion: a comparison of clinical outcome parameters, complication rates, and costs between outpatient and inpatient surgery groups, with a literature review

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