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No Significant Differences in Postoperative Complications Between Outpatient and Inpatient Single-level or
Anna M Ifarraguerri1, Alisa Malyavko1, William T Stoll1
1Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC.
Insights
Outpatient cervical disk replacement (CDR) is as safe as inpatient procedures for both single and multiple levels. This study found similar surgical outcomes and complication rates, supporting outpatient CDR's viability.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spine Surgery
Background:
- Cervical disk replacement (CDR) is a motion-preserving alternative to fusion, potentially reducing adjacent segment disease.
- Existing research on outpatient vs. inpatient CDR is limited by small sample sizes and short follow-up periods.
- Investigating the safety of outpatient CDR is crucial given its increasing desirability.
Purpose of the Study:
- To compare the safety and surgical outcomes of outpatient versus inpatient single-level and multiple-level cervical disk replacement (CDR).
- To analyze one- and two-year surgical outcomes and 90-day medical complications associated with CDR settings.
- To leverage a large patient database for robust statistical analysis of CDR safety profiles.
Main Methods:
- Retrospective cohort analysis of a large patient database (2010-2019).
- Identification of patients undergoing single-level and multiple-level CDR with at least two years of follow-up.
- Subdivision into outpatient and inpatient groups for univariate and multivariable analyses.
Main Results:
- In the single-level CDR cohort, outpatient procedures showed lower odds of requiring decompressive laminectomy at one year (OR=0.471).
- No significant differences in one- and two-year surgical complications were observed between outpatient and inpatient single-level CDR.
- Multivariate analysis revealed no significant differences in 90-day complications or long-term surgical outcomes for outpatient vs. inpatient multiple-level CDR.
Conclusions:
- Outpatient single-level and multiple-level cervical disk replacement (CDR) demonstrate a comparable safety profile to inpatient procedures.
- The findings support the feasibility and safety of performing CDR in an outpatient setting.
- This study provides evidence for the expanded use of outpatient CDR based on large-scale data.
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.
