Comparison of Inpatient vs. Outpatient Anterior Cervical Discectomy

Comparison of Inpatient vs. Outpatient Anterior Cervical Discectomy

Abstract and Background

Abstract
Background: Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P).
Methods: All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF) were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care.
Results: 64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14), older age (1), and patient preference (2). At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia.
Conclusion: In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.
Background
Spinal surgery is increasingly being done in the outpatient setting. Reasons suggested for this include the refinement of facilities and systems for ambulatory surgery, increasing utilization of minimally-invasive approaches, increasing utilization of allograft instead of autograft for arthrodesis with associated decrease in graft site pain and morbidity, and improvements in tools and techniques for spinal instrumentation.

Because of short operative time and moderate postoperative pain, anterior cervical discectomy and fusion with plating (ACDF+P) may be well-suited to be performed in the outpatient setting. However, some potential complications of ACDF+P, including postoperative hematoma, may preclude safely performing the procedure in outpatients. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P).