No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-Level or Multiple-Level Cervical Disk Replacement for Cervical Radiculopathy

Anna M. Ifarraguerri, BS; Alisa Malyavko, MS; William T. Stoll, MD; Alex Gu, MD; Savyasachi C. Thakkar, MD; Tushar Patel, MD


Spine. 2022;47(22):1567-1573. 

In This Article

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.[1] 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).[2] 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).[3]

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.[6] 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.[22] 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.