Elsevier

Journal of Clinical Neuroscience

Volume 34, December 2016, Pages 166-168
Journal of Clinical Neuroscience

Clinical Study
Outpatient anterior cervical discectomy and fusion: A meta-analysis

https://doi.org/10.1016/j.jocn.2016.06.012Get rights and content

Highlights

  • More than 95% of reported outpatient anterior cervical discectomy and fusion (ACDF) cases have been published since 2011.

  • Nearly two-thirds of outpatient ACDF cases involve single-level fusion.

  • Fewer than 1% of outpatient ACDF cases involve fusion of more than two levels.

  • Reported readmission/complication rates of outpatient ACDF are comparable to inpatient ACDF.

Abstract

Anterior cervical discectomy and fusion (ACDF) performed as an outpatient has become increasingly common for treating cervical spine pathology, largely due to its cost savings compared with inpatient ACDF. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature. The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Data from studies meeting inclusion criteria (minimum of 25 patients, control group of inpatient ACDF patients, non-duplicative data source) was then categorized and assimilated for analysis. Seven studies met inclusion criteria, encompassing a 21-year timespan. Each provided Oxford Center for Evidence-Based Medicine Level 3 evidence. The studies yielded a total of 2448 outpatient ACDF patients; only 125 (5.1%) originated from studies published prior to 2011. Single-level surgery occurred in 63.8% of patients, with 0.5% extending beyond two-level fusions. The overall complication rate was 1.8% (mean follow-up of 141.2 days); only 2% of patients required readmission. In conclusion, outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those (2–5%) associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.

Introduction

First described by Smith, Robinson and Cloward in 1958, anterior cervical discectomy and fusion (ACDF) has become increasingly common treatment for cervical spine pathology [1], [2], [3]. Cost-saving strategies for surgical care have increased in popularity due to the unsustainable growth in healthcare costs, particularly the 7% of the United States gross domestic product (GDP) comprised by surgical care alone [4].

As a result of such strategies, ACDF performed on an outpatient basis has increased in popularity, since outpatient surgeries cost approximately 30% less than comparable inpatient procedures [5], [4]. Nearly all outpatient ACDF patient reports have originated from single-center studies, with the procedure yet to be addressed via a meta-analysis of the peer-reviewed literature [6], [7], [8], [9], [10]. The rise of outpatient ACDF provides an ideal opportunity for a meta-analysis.

Section snippets

Methods

The Entrez gateway of the PubMed database was used to conduct a comprehensive literature search for articles published in English up to 3/9/16. Following this search, bibliographies from selected studies were subsequently culled for acquisition of additional pertinent articles. The inclusion criteria for the meta-analysis was as follows: (a) Minimum of 25 outpatient ACDF patients reported, (b) Data source not duplicative with a more voluminous published study, (c) Providing Oxford Center for

Results

The initial literature and bibliography search yielded a total of 13 studies examining outpatient ACDF [13], [14], [15], [16], [17], [18] (Table 1). Of these studies, six failed to meet inclusion criteria; five failed to include an inpatient ACDF control group for comparison, while a sixth relied upon data used in a larger published study [12] (Table 2).

The seven studies meeting inclusion criteria encompassed a 21-year timespan from 1996 to 2016, and yielded a total of 2448 outpatient ACDF

Discussion

The majority of studies involving outpatient ACDF have originated from single institutions. Given that the cost advantages of outpatient surgery have resulted in increasing popularity of outpatient ACDF, this meta-analysis was performed in order to provide a more general examination.

The results from this meta-analysis comprising nearly 2500 outpatient ACDF patients are striking. Although the first outpatient ACDF series was published more than two decades ago, more than 95% of patients have

Conclusions

Outpatient ACDF has become increasingly popular, with more than 95% of patients represented by studies published since 2011. Nearly two-thirds of outpatient ACDFs underwent single-level fusion, with virtually none undergoing 3+ level ACDF. Outpatient ACDF is safe, with a low readmission rate and complication rates comparable to those associated with inpatient ACDF. These findings support an argument for increasing ACDFs performed on an outpatient basis in appropriately selected patients.

Conflicts of Interest/Disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

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Cited by (59)

  • Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time

    2022, North American Spine Society Journal
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    Nonetheless, recent studies show that utilization rates for outpatient anterior cervical surgery continue to increase [14–16]. A number of studies conducted over the past decade have demonstrated that following careful patient selection, outpatient anterior cervical surgery can be performed with similar outcomes and morbidity relative to the inpatient setting [17–23]. Thus, the observed increase in outpatient volume may stem from more surgeons performing this procedure in the outpatient setting after being convinced by the findings of these studies.

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