Abstract and Introduction
Study Design: Retrospective cohort analysis.
Objective: To investigate the safety profile of outpatient versus inpatient single-level and multiple-level cervical disk replacement (CDR) by analyzing one- and two-year surgical outcomes and 90-day medical complications using a large patient database.
Summary of Background Data: CDR is becoming a more desirable option for patients undergoing cervical spine procedures. Unlike anterior cervical diskectomy and fusion, CDR is motion-preserving and has been shown to reduce rates of adjacent segment disease. Current literature investigating outpatient versus inpatient CDR has shown a similar safety profile among the two cohorts. However, most of these studies have relatively small sample sizes with short-term follow-up.
Materials and Methods: A retrospective cohort study was done using the PearlDiver patient database between 2010 and 2019. Patients who underwent single-level and multiple-level CDR with a follow-up of at least two years were identified. Patients within each procedure cohort were subdivided into an outpatient and an inpatient group. Univariate and multivariable analyses were performed.
Results: In total, 2294 patients underwent single-level CDR of which 506 patients underwent outpatient CDR and 1788 underwent inpatient CDR. In total, 236 patients underwent multiple-level CDR of which 49 patients underwent outpatient CDR and 187 underwent inpatient CDR. In the single-level CDR cohort, patients undergoing outpatient CDR were found to have lesser odds of a decompressive laminectomy at one year following the initial procedure (odds ratio=0.471; 95% confidence interval: 0.205–0.945; P=0.05). No significant differences in one- and two-year surgical complications, or 90-day postoperative complications, were found on multivariate analysis of outpatient versus inpatient multiple-level CDR.
Conclusion: Our study found that performing single-level and multiple-level CDR on an outpatient basis has a similar safety profile to patients who underwent these procedures in an inpatient setting.
Level of Evidence: 3
Cervical spine disorders represent a category of common medical problems worldwide. Cervical neck pain is the fourth leading cause for years lived with disability, with a 54% increase from 1990 to 2013. Multiple long-term studies support anterior cervical diskectomy and fusion (ACDF) as an effective treatment option for patients with neck pain due to cervical myelopathy, radiculopathy, and cervical degenerative disk disease (CDDD). However, ACDF does not preserve the natural segmental motion of the spine, resulting in a reduced range of motion and an increased risk of developing adjacent segment disease (ASD).
Cervical disk replacement (CDR) has gained more significant popularity in the past decade.[4,5] It is gaining traction as an option for operative management of cervical conditions, including cervical myelopathy, radiculopathy, and CDDD. In comparison to traditional ACDF, CDR has become a more desirable option for treating CDDD due to its ability to preserve motor function and restore the biomechanical properties of the intact cervical spine,[7–9] preventing ASD.[10–12]
Outpatient CDR has become increasingly popular in recent years.[4,13] With advances in anesthesiology and the development of Enhanced Recovery After Surgery (ERAS) protocols, many surgeries can now be performed as outpatient procedures that were previously confined to inpatient hospitals.[14,15] As the population continues to age, the number of CDRs performed annually increases by 17% per year.[4,16] Furthermore, outpatient surgery increases patient satisfaction[17,18] and reduces hospital-related healthcare costs. Compared with inpatient procedures, outpatient CDR reduced the mean cost by 42% to 84%.[19,20]
Although several studies have compared outpatient versus inpatient CDR, there is a lack of literature evaluating the long-term safety profile, specifically long-term revision rates, of outpatient single-level or multiple-level CDR.[11,21] Prior studies mainly evaluate 30-day complication rates without extending to a one- or two-year follow-up. In addition, these studies are retrospective cohort studies done at a single institution.[11,21,22] The present study aimed to use a large database to investigate (1) the 90-day complication rates, one-year revision rates, and two-year revision rates for patients undergoing single-level outpatient CDR versus single-level inpatient CDR and (2) the 90-day complication rates, one-year revision rates, and two-year revision rates for patients undergoing multiple-level outpatient CDR compared with multiple-level inpatient CDR. We predict that there will be no difference between inpatient versus outpatient revision rates for patients undergoing single-level or multiple-level CDR.
Spine. 2022;47(22):1567-1573. © 2022 Lippincott Williams & Wilkins