Safety and cost-effectiveness of outpatient cervical disc arthroplasty

Background: To assess the safety, clinical efficacy, and cost-effectiveness of outpatient cervical disc arthroplasty.

Methods: We retrospectively reviewed the records of 26 consecutive patients who underwent outpatient cervical disc arthroplasty between February 2009 and May 2010 in order to assess the safety, clinical efficacy, and cost-effectiveness of the process. Fourteen patients were operated in a -free-standing practice-based ambulatory spine surgery center (MSC) and 12 patients were operated in a hospital-based outpatient surgery center. The mean age of the patient sample was 46 years; 56% were female and 44% were male. Indications for surgery consisted of cervical radiculopathy secondary to single-level soft disc herniation. Charts were reviewed to define patient demographics and medical comorbidities. Operative data, including levels treated, surgery time, time to discharge, and intraoperative complications were collected. Clinical outcomes were collected using the PhDx Clinical Outcomes Database. Need for hospital transfer from the ambulatory surgical center (ASC), emergency room visits, and subsequent hospital admission in the perioperative period were determined from patient records. Complications, patient satisfaction, and outcome were ascertained via review of notes from the first post-operative visit.

Results: There was no mortality and no major complications. Pain was present in 100% and motor deficit in 33% of the patients. There were no co-morbidities reported in the group. There were no cases that required hospital transfer and there were no post-op Emergency Room visits or subsequent hospitalization. At the time of the first post-operative visit, 100% of the patients believed that they were improved and no patient had any post-operative complications. The cost of outpatient single-level cervical disc arthroplasty was 62% less than the outpatient single-level cervical anterior discectomy with fusion using allograft and plate and 84% less than the inpatient single-level cervical disc arthroplasty.

Conclusions: Outpatient cervical disc arthroplasty is safe and clinically efficacious in selected patients and is cost-effective compared with both inpatient cervical disc arthroplasty and outpatient anterior discectomy with fusion.