Findings support safety of ACDF performed in an outpatient ambulatory setting
ORLANDO, Fla. — A database study presented here indicated that anterior cervical discectomy and fusion can be performed safely in an outpatient ambulatory setting with significantly lower rates of 30-day morbidity and return to OR compared with procedures performed in an inpatient setting.
“ACDF (anterior cervical discectomy and fusion) can be performed with similar or potentially greater safety and quality in the ambulatory surgery center setting by voiding those nosocomial risks and medical errors associated with the inpatient setting. Ambulatory surgery centers may allow for lower 30-day surgical morbidity and a return to the OR compared to the inpatient-hospital setting. In an effort to decrease cost of care, surgeons can safely consider performing ACDF in an ambulatory surgery center environment in healthy patients with adequate observation time prior to discharge,” Sheyan J. Armaghani, MD, said during his presentation at the Cervical Spine Research Society Annual Meeting, here.
Armaghani and colleagues used the National Surgical Quality Improvement Program database to identify 6,120 patients who underwent ACDF in the inpatient setting and 1,168 patients who had ACDF performed as an outpatient procedure at an ambulatory surgery center. The investigators used propensity score matching and multivariate logistic regression analysis to compare perioperative outcomes and morbidity between the groups.
Unadjusted findings showed significantly lower rates of major morbidity and return to the OR within 30 days for the outpatient group compared with the inpatient cohort. After propensity matching of 650 inpatients and 792 outpatients, investigators found similar results. Based on baseline 32 covariates, the rate of major morbidity was 1.4% for the outpatient group vs. 3.1% for the inpatient group. The rate for return to the OR within 30 days of the procedure was 0.34% for the outpatient group vs. 1.4% for the inpatient group.
After multivariate regression, patients who underwent ACDF surgery in an outpatient setting had 58% lower odds of having a major morbidity, Armaghani said, and they had 80% lower odds of returning to the OR within 30 days. – by Robert Linnehan
Armaghani S. Paper #24. Presented at: Cervical Spine Research Society Annual Meeting; Dec. 4-6, 2014; Orlando, Fla.
Disclosure: Armaghani has no relevant financial disclosures.