Finest Practices for Outpatient Anterior Cervical Surgical procedure: Outcomes From a Delphi Panel.
Backbone (Phila Pa 1976). 2017 Jun 01;42(11):E648-E659
Authors: Mohandas A, Summa C, Worthington WB, Lerner J, Foley KT, Bohinski RJ, Lanford GB, Holden C, Wohns RNW
STUDY DESIGN: Delphi Panel professional panel consensus and narrative literature assessment.
OBJECTIVE: To acquire professional consensus on greatest practices for affected person choice and perioperative resolution making for outpatient anterior cervical surgical procedure (anterior cervical disc fusion (ACDF) and cervical whole disc substitute (CTDR)).
SUMMARY OF BACKGROUND DATA: Backbone surgical procedure in ambulatory settings is changing into a most well-liked choice for each sufferers and suppliers. The transition from conventional inpatient environments has been enabled by innovation in anesthesia protocols and surgical approach, in addition to favorable economics. Research have demonstrated that anterior cervical surgical procedure (ACDF and CTDR) could be carried out safely on an outpatient foundation. Nevertheless, apply pointers and evidence-based protocols to tell greatest practices for the secure and environment friendly efficiency of those procedures in same-day, ambulatory settings are missing.
METHODS: A panel of 5 neurosurgeons, three anesthesiologists, one orthopedic backbone surgeon, and a registered nurse was convened to comprise a multidisciplinary professional panel. A 3-round modified-Delphi methodology was used to generate best-practice statements. Predetermined consensus was set at 70% for every best-practice assertion.
RESULTS: A complete of 94 consensus statements had been reviewed by the panel. After three rounds of assessment, there was consensus for 83 best-practice statements, whereas 11 statements failed to realize consensus. All statements inside a number of perioperative classes (and subcategories) achieved consensus, together with preoperative evaluation (n?=?eight), home-care/follow-up (n?=?2), second-stage restoration (n?=?18), supplier economics (n?=?eight), affected person training (n?=?14), discharge standards (n?=?four), and hypothermia prevention (n?=?6).
CONCLUSION: This examine obtained expert-panel consensus on greatest practices for affected person choice and perioperative resolution making for outpatient anterior cervical surgical procedure (ACDF/CTDR). Given a paucity of pointers and a scarcity of established care pathways for ACDF/CTDR in same-day, ambulatory settings, outcomes from this examine can complement out there proof in assist of native protocol improvement for suppliers contemplating a transition to the outpatient setting.
LEVEL OF EVIDENCE: four.
PMID: 27753787 [PubMed – indexed for MEDLINE]