Outpatient anterior cervical discectomy and fusion associated with improved surgical quality

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Sheyan Armaghani, School of Medicine, Vanderbilt University, USA, presented a study at the Cervical Spine Research Society Annual Meeting (CSRS; 3–6 December 2014, Orlando, USA) supporting the safety and efficacy of anterior cervical discectomy and fusion (ACDF) in ambulatory surgery centres (ASCs).

If the safety and efficacy of ASCs can be established, they may offer surgeons an attractive alternative to more expensive inpatient surgery. “In an effort to decrease cost of care, surgeons can safely consider performing ACDF in an ambulatory surgery centre environment in healthy patients with adequate observation time prior to discharge,” said Armaghani.

Armaghani and colleagues examined a nationwide, prospective quality improvement registry (National Surgical Quality Improvement Program) in order to compare the quality of ACDF in an outpatient ASC vs inpatient setting. Patients were divided into outpatient and inpatient cohorts and all 30-day surgical morbidity and mortality was compared between the two groups. The investigators used propensity score matching and multivariate logistic regression analysis to compare perioperative outcomes and morbidity between the groups.

In total, 7,288 cases (6,120 inpatient and 1,168 outpatient) were identified by the authors. Unadjusted rates of major morbidity were significantly higher in the inpatient setting when compared to the outpatient setting (4.5% vs 0.95% p<0.001). Furthermore, Armaghani told delegates that the proportion of patients returning to the operating room within 30 days was also higher in inpatient treatment than outpatient (2.0% vs 0.3% p<0.001).      

Similar results were found after 650 inpatients and 792 outpatients were propensity matched. Based on 32 covariates, rates of major morbidity (1.4% vs 3.1% p=0.03) and return to the operating room (0.34% vs 1.4% p=0.04) remained lower after outpatient ACDF. According to Armaghani, “Multivariate regression showed that ACDF performed in the outpatient setting had 58% less chance of having a major morbidity and 80% less chance of a return to the operating room within 30 days.”

Armaghani closed the presentation stating that “ACDF can be safely performed in the outpatient ambulatory setting. By avoiding nosocomial risks and medical errors associated with the inpatient hospital setting, ASCs may allow for lower 30-day surgical morbidity and return to the operating room.”