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Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series

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

Keywords : Ambulatory Surgical Procedures,Arthrodesis,cerebrospinal fluid,Cerebrospinal Fluid Leak,Cervical Vertebrae,Comorbidity,complications,Diskectomy,Drainage,etiology,Hematoma,Hospitalization,Hospitals,Humans,Inpatients,instrumentation,methods,Middle Aged,Patient Selection,Patients,Retrospective Studies,Spinal Fusion,surgery,Texas,Titanium,, Inpatient,Vs,Outpatient,Anterior, ankylosing spondylitis and nerve pain

Date of Publication : 2009 Mar 5

Authors : Liu JT;Briner RP;Friedman JA;

Organisation : Departments of Surgery, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, College Station, Texas, USA. jtliu@medicine.tamhsc.edu

Journal of Publication : BMC Surg

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/19265540

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