Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel

Area of Science:

• Spine Surgery
• Outpatient Procedures
• Cervical Spine Surgery

Background:

• Ambulatory spine surgery is increasingly preferred by patients and providers due to innovations in anesthesia, surgical techniques, and economics.
• Anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR) have been shown to be safely performable in outpatient settings.
• A lack of established practice guidelines and evidence-based protocols hinders the safe and efficient performance of these procedures in ambulatory settings.

Purpose of the Study:

• To achieve expert consensus on optimal patient selection for outpatient anterior cervical surgery.
• To establish best practices for perioperative decision-making in same-day anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR).
• To provide evidence-based guidance for developing local protocols for outpatient cervical spine surgery.

Main Methods:

• A multidisciplinary expert panel comprising neurosurgeons, anesthesiologists, an orthopedic spine surgeon, and a registered nurse was convened.
• A modified-Delphi method involving three rounds was employed to generate and refine best-practice statements.
• Consensus was predefined at 70% for each best-practice statement.

Main Results:

• The panel reviewed 94 consensus statements, achieving consensus on 83 statements after three rounds.
• Consensus was reached across multiple perioperative categories, including preoperative assessment, patient education, discharge criteria, and hypothermia prevention.
• Eleven statements did not achieve the 70% consensus threshold.

Conclusions:

• This study successfully established expert consensus on best practices for patient selection and perioperative management in outpatient ACDF and CTDR.
• The findings serve as a valuable supplement to existing evidence, aiding providers in developing protocols for transitioning to outpatient cervical spine surgery.
• The consensus statements address critical aspects of care, facilitating the safe and efficient implementation of ambulatory anterior cervical surgery.