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Outcomes of Outpatient Cervical Disc Replacement in an Ambulatory Surgical Center: An Analysis of 1,007 Patients
Ankit Hirpara1, Sawyer Scheitler2, Brandon Hirsch2
1Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH.
Study Design:
Retrospective cohort.
Objective:
To evaluate the efficacy, peri-discharge safety, and reimbursement of single-level and multi-level cervical disc replacements (CDRs) performed in a freestanding ambulatory surgical center (ASC).
Summary Of Background Data:
CDR is performed to treat spinal stenosis, disc degeneration, disc herniation, and other degenerative pathologies. Recently, there has been a shift from performing CDRs in inpatient settings to ASCs. However, there is limited literature analyzing the outcomes, safety, and economic implications of this transition.
Methods:
A retrospective analysis was performed on patients over 18 years old who underwent single-level and multi-level CDR at an ASC between 2018 and 2024. Demographics, surgical characteristics, peri-operative data, insurance type, peri-discharge complications, and reimbursement data were collected. Comparative analyses were conducted between one-, two-, three-, and four-level cohorts using one-way analysis of variance for continuous variables and chi-square or Fisher's exact tests for categorical variables.
Results:
This study included 1,007 patients (n=576 males, n=430 females, n=1 undisclosed) who underwent 1,043 CDRs. Of the CDRs, 433 were single-level, 579 were two-level, 28 were three-level, and 3 were four-level. The average surgical time for all CDRs was 85.6±29.1 minutes (single-level: 70.6±24.9 minutes, two-level: 94.2±26.0 minutes, three-level: 128.3±24.0 minutes, four-level: 157.7±15.5 minutes) (P<0.001). The average reimbursement for all CDRs was $27,460.91±$9,773.70 (single-level: $24,550.39±$9,297.89, two-level: $29,217.12±$9,517.75, three-level: $34,057.19±$8,630.15, four-level: $47,033.33±$577.35) (P<0.001). There were no complications in the immediate peri-discharge period, and no patients required hospital transfer. All patients were discharged within 24 hours.
Conclusion:
Single-level and multi-level CDRs may be performed in an ASC with a favorable peri-discharge safety profile. CDR in an ASC may also be cost-efficient compared to inpatient surgery. Future studies with longer-term follow-up are needed to better characterize post-discharge outcomes.
Level Of Evidence:
III.
