scholarly journals Instrumented Outpatient Anterior Cervical Discectomy and Fusion: Is it Safe?

2012 ◽  
Vol 97 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Courtney S Sheperd ◽  
William F Young
Keyword(s):  
Outpatient Surgery ◽  
Cost Savings ◽  
Anterior Cervical Discectomy ◽  
Ambulatory Setting ◽  
Outpatient Basis ◽  
Potential Cost ◽  
Cervical Discectomy ◽  
Hospital Emergency Room ◽  
Cervical Swelling ◽  
High Degree

Abstract Anterior cervical discectomy and fusion procedures are one of the most common procedures performed in spinal surgery. Increasingly they are being performed on an outpatient basis. The primary impetus for performing procedures as an outpatient is potential cost savings. However, there are few studies discussing the safety of performing the procedure in an ambulatory setting. This is a retrospective review of our initial experience in performing anterior cervical discectomy and fusion procedures with instrumentation (ACDFI) in an ambulatory surgery center dedicated to spine surgery. Patients were selected for outpatient surgery if they had limited co-morbidities and the surgery involved only 1 or 2 levels. One hundred fifty-two patients underwent outpatient ACDFI during the study period (2007–2009). Six patients returned to the hospital emergency room after discharge. The reasons for evaluation included 2 for neck pain, 1 for dysphagia, 1 for vocal cord paralysis and dysphagia, 1 for nausea, and 1 for cervical swelling. Only 1 of the 6 patients required admission to the hospital. None of the 6 suffered any long-term sequelae. The overall complication rate was 3.9%. A self-reported survey was completed by 75 patients within 6 months of surgery, and there was a 100% satisfaction rate among responders. ACDFI can be performed safely on an outpatient in selected patients with a high degree of patient satisfaction. Our experience is consistent with those of previous investigators.

Outpatient and inpatient readmission rates of 3- and 4-level anterior cervical discectomy and fusion surgeries

2019 ◽  
Vol 31 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Syed I. Khalid ◽  
Ryan Kelly ◽  
Adam Carlton ◽  
Owoicho Adogwa ◽  
Patrick Kim ◽  
...  
Keyword(s):  
Outpatient Surgery ◽  
Perioperative Complications ◽  
The United States ◽  
Anterior Cervical Discectomy ◽  
Ambulatory Setting ◽  
Readmission Rates ◽  
Cervical Discectomy ◽  
Increased Risk ◽  
Artery Disease ◽  
Lost To Follow Up

OBJECTIVEWith the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF).METHODSThis was a retrospective study of 337 3- and 4- level ACDF procedures in 332 patients (5 patients had both primary and revision surgeries that were included in this total of 337 procedures) between May 2012 and June 2017. In total, 331 procedures were analyzed, as 6 patients were lost to follow-up. Outpatient surgery was performed for 299 procedures (102 4-level procedures and 197 3-level procedures), and inpatient surgery was performed for 32 procedures (11 4-level procedures and 21 3-level procedures). Age, sex, comorbidities, number of fusion levels, pain level, and perioperative complications were compared between both cohorts.RESULTSAnalysis was performed for 331 3- and 4-level ACDF procedures done at 6 different hospitals. The overall 30-day readmission rate was 1.2% (outpatient 3 [1.0%] vs inpatient 1 [3.1%], p = 0.847). Outpatients had increased readmission risk, with comorbidities of coronary artery disease (OR 1.058, p = 0.039), autoimmune disease (OR 1.142, p = 0.006), diabetes (OR 1.056, p = 0.001), and chronic kidney disease (OR 0.933, p = 0.035). Perioperative complications of delirium (OR 2.709, p < 0.001) and surgical site infection (OR 2.709, p < 0.001) were associated with increased risk of 30-day hospital readmission in outpatients compared to inpatients.CONCLUSIONSThis study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.

Internal Jugular Venous Thrombosis as a Complication after an Elective Anterior Cervical Discectomy

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. E705-E705 ◽  
Author(s):  
Aftab Karim ◽  
Jill Knapp ◽  
Anil Nanda
Keyword(s):  
Venous Thrombosis ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Computed Tomographic ◽  
First Case ◽  
Cervical Swelling ◽  
Venous Bleeding ◽  
History Of ◽  
Surgery Department

Abstract OBJECTIVE: Anterior cervical discectomy is one of the most common spine procedures in neurosurgery. Various complications, including hoarseness, hematoma, and dysphagia, have been reported in the literature. We report the first case of internal jugular venous thrombosis after an elective anterior cervical discectomy. CLINICAL PRESENTATION: A 35-year-old woman with past medical history significant only for hypercholesterolemia and cholecystectomy underwent an anterior cervical discectomy with fusion for a symptomatic cervical disc at the C5–C6 level. Intraoperatively, the patient had venous bleeding, which was adequately controlled. The procedure was completed with good hemostasis before closure. The patient was discharged home 1 day after the surgery. She was readmitted 5 days later with a 2-day history of a swollen right neck. The patient had no respiratory symptoms, but did report mild dysphagia. A hematoma was suspected. INTERVENTION: A computed tomographic scan of the neck was performed when the patient presented with cervical swelling. This was suggestive of a right internal jugular venous thrombosis. This diagnosis was confirmed with cervical ultrasound. The patient was seen by the vascular surgery department. The hospital course was otherwise uneventful and the patient was discharged 3 days later on oral anticoagulation with warfarin. CONCLUSION: This is the first report of internal jugular venous thrombosis after an elective anterior cervical discectomy. Internal jugular venous thrombosis should be considered in the differential diagnosis of a patient presenting with cervical swelling after an anterior cervical discectomy.

scholarly journals Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 30-45 ◽  
Author(s):  
Ketan Yerneni ◽  
John F Burke ◽  
Pranathi Chunduru ◽  
Annette M Molinaro ◽  
K Daniel Riew ◽  
...  
Keyword(s):  
Safety Profile ◽  
Meta Analysis ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Level I ◽  
High Level

ABSTRACT BACKGROUND Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE To review the medical literature on the safety of outpatient ACDF. METHODS We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P &lt; .001), mortality (P &lt; .001), and hospitalization duration (P &lt; .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.

Anterior Cervical Discectomy and Autologous Fusion on an Outpatient Basis

Neurosurgery ◽  
1996 ◽  
Vol 39 (3) ◽  
pp. 645-646
Author(s):  
Mitchell R. Gropper ◽  
Theodore W. Eller
Keyword(s):  
Anterior Cervical Discectomy ◽  
Outpatient Basis ◽  
Cervical Discectomy

Is Outpatient Laparoscopic Cholecystectomy Safe and Cost-effective?

1999 ◽  
Vol 90 (6) ◽  
pp. 1746-1755. ◽  
Author(s):  
Lee A. Fleisher ◽  
Kelvin Yee ◽  
Keith D Lillemoe ◽  
Mark A. Talamini ◽  
Charles J. Yeo ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Outpatient Surgery ◽  
Operating Time ◽  
Cost Savings ◽  
Postoperative Nausea And Vomiting ◽  
Cost Effective ◽  
Outpatient Setting ◽  
Postanesthesia Care Unit ◽  
Outpatient Basis ◽  
Home Setting

Background There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting. Methods Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed. Results Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient. Conclusions The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.

Outpatient vs Inpatient Anterior Cervical Discectomy and Fusion: A Population-Level Analysis of Outcomes and Cost

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 454-464 ◽  
Author(s):  
David A Purger ◽  
Arjun V Pendharkar ◽  
Allen L Ho ◽  
Eric S Sussman ◽  
Lingyao Yang ◽  
...  
Keyword(s):  
Charlson Comorbidity Index ◽  
Population Level ◽  
Early Discharge ◽  
Anterior Cervical Discectomy ◽  
Ambulatory Setting ◽  
Inpatient Setting ◽  
Cervical Discectomy ◽  
Ambulatory Patients ◽  
Comorbidity Index ◽  
Ed Visits

Abstract BACKGROUND Outpatient anterior cervical discectomy and fusion (ACDF) is a promising candidate for US healthcare cost reduction as several studies have demonstrated that overall complications are relatively low and early discharge can preserve high patient satisfaction, low morbidity, and minimal readmission. OBJECTIVE To compare clinical outcomes and associated costs between inpatient and ambulatory setting ACDF. METHODS Demographics, comorbidities, emergency department (ED) visits, readmissions, reoperation rates, and 90-d charges were retrospectively analyzed for patients undergoing elective ACDF in California, Florida, and New York from 2009 to 2011 in State Inpatient and Ambulatory Databases. RESULTS A total of 3135 ambulatory and 46 996 inpatient ACDFs were performed. Mean Charlson comorbidity index, length of stay, and mortality were 0.2, 0.4 d, and 0% in the ambulatory cohort and 0.4, 1.8 d, and 0.04% for inpatients (P &lt; .0001). Ambulatory patients were younger (48.0 vs 53.1) and more likely to be Caucasian. One hundred sixty-eight ambulatory patients (5.4%) presented to the ED within 30 d (mean 11.3 d), 51 (1.6%) were readmitted, and 5 (0.2%) underwent reoperation. Among inpatient surgeries, 2607 patients (5.5%) presented to the ED within 30 d (mean 9.7 d), 1778 (3.8%) were readmitted (mean 6.3 d), and 200 (0.4%) underwent reoperation. Higher Charlson comorbidity index increased rate of ED visits (ambulatory operating room [OR] 1.285, P &lt; .05; inpatient OR 1.289, P &lt; .0001) and readmission (ambulatory OR 1.746, P &lt; .0001; inpatient OR 1.685, P &lt; .0001). Overall charges were significantly lower for ambulatory ACDFs ($33 362.51 vs $74 667.04; P &lt; .0001). CONCLUSION ACDF can be performed in an ambulatory setting with comparable morbidity and readmission rates, and lower costs, to those performed in an inpatient setting.

scholarly journals Minimally Invasive Posterior Cervical Discectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Seokchun Lim ◽  
Thomas Marcus Zervos ◽  
Travis Hamilton ◽  
Victor Chang
Keyword(s):  
Minimally Invasive ◽  
Healthcare Cost ◽  
Cost Savings ◽  
Herniated Disc ◽  
Ambulatory Setting ◽  
Invasive Technique ◽  
Foraminal Stenosis ◽  
Illustrative Case ◽  
Cervical Discectomy ◽  
Splitting Technique

Abstract Minimally invasive posterior cervical microdiscectomy is an appropriate surgical approach for patients with foraminal stenosis from herniated disc with radicular symptoms that is not responsive to conservative management. While anterior cervical discectomy and fusion (ACDF) or arthroplasty is increasingly utilized to treat herniated disc, a posterior approach eliminates the risk of potential approach related injuries to the esophagus, carotid artery, or recurrent laryngeal nerve. Additional benefits of posterior decompression include avoidance of instrumentation, which represents an increased healthcare cost, as well as potential long-term risks of adjacent-level pathologies or device failures.  A traditional open posterior cervical approach has the potential to cause significant postoperative pain due to dissection of the paraspinal musculature and the potential for disrupting the posterior tension band with inadvertent injury to the interspinous ligaments. Such disadvantages are reduced by utilizing the minimally invasive technique where a small tubular working channel is placed through a muscle splitting technique via a paramedian approach. This technique minimizes the need for muscle stripping, and thus decreases postoperative functional and structural disturbance. Discectomy in this case can also be safely performed with minimal retraction at the axilla of the nerve root. Additionally, this approach can be utilized in an ambulatory setting, which coupled with the lack of any additional instrumentation helps contribute to the overall healthcare cost savings of such a procedure.  This video describes how the minimally invasive posterior cervical discectomy can be effectively and safely performed in this illustrative case. The patient consented to the procedure and publication.

scholarly journals Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ketan Yerneni ◽  
John F Burke ◽  
K Daniel Riew ◽  
Vincent C Traynelis ◽  
Lee A Tan
Keyword(s):  
Perioperative Complications ◽  
Meta Analysis ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Disc Disease ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
High Level

Abstract INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent surgical procedures and is used to treat several cervical spinal pathologies, including herniated discs, degenerative disc disease, and spondylosis. With the increasing prevalence of ACDF procedures, this procedure has become an excellent target for clinical optimization. Indeed, in recent years, ACDF has become increasingly offered on an outpatient basis. To date, the incidence and dynamics of perioperative complications and safety surrounding outpatient ACDF remain poorly resolved. METHODS We systematically reviewed the literature for articles published by April 2018 describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing overall and specific complications between the inpatient and outpatient ACDF groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P < .001), mortality (P < .001), and hospitalization duration (P < .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option.

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