Feasibility of anterior cervical discectomy and fusion as an outpatient procedure

Background: Anterior cervical discectomy and fusion (ACDF) procedures are increasingly being managed on an outpatient basis. Currently there are no definitive guidelines within the literature that delineate which patient population can safely be managed as such. The purpose of this study is to demonstrate that ACDF procedures, within a selective patient population at our institution, can be safely performed on an outpatient basis.

Methods: This is a retrospective chart review within one physician's practice of patients undergoing instrumented ACDF procedures using allograft. This sample included 117 patients who underwent one- and two-level ACDF procedures from November 2005 to April 2009. Hospital length of stay and hospital readmissions were noted. Complication rates in the outpatient population were assessed to determine the feasibility of outpatient management for selective patients undergoing ACDF procedures.

Results: A total of 59 patients (50%) were treated on an outpatient basis. Sixty-eight patients underwent single level ACDF procedures, 38 patients (56%) of which were discharged on the same day. Forty-nine patients underwent two-level ACDF procedures, 21 patients (43%) of which were discharged on the same day. There was one complication (1.4%) in patients who were discharged on the same day. That patient required readmission for 23-hour observation secondary to neck swelling.

Conclusions: ACDF procedures involving single and two-level fusions can safely be performed on an outpatient basis. Complication rates associated with this procedure are low, with critical postoperative complications involving respiratory compromise occurring very infrequently and in the immediate postoperative period.