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OutpatientAnterior Cervical Discectomy and Fusion is Associated with Fewer Short-Term Complications inOne-and Two-Level Cases: A Propensity-Adjusted Analysis.
Spine 2016 November 19
STUDY DESIGN: Retrospective cohort study of prospectively-collected data from the National Surgical Quality Improvement Program (NSQIP) database.
OBJECTIVE: To determine the postoperative morbidity of one-level and two-level outpatient anterior cervical discectomy and fusion (ACDF) relative to inpatient cases, and risk factors for post-discharge complications.
SUMMARY OF BACKGROUND DATA: ACDF is increasingly performed as an outpatient procedure, with evidence demonstrating outpatient one-level ACDF to be associated with fewer postoperative complications than inpatients. The postoperative morbidity and safety of outpatient two-level ACDF as a separate cohort is not well understood.
METHODS: ACDF cases from NSQIP 2011-2014 were identified. Differences in baseline characteristics between inpatient and outpatient cases were determined, and propensity score adjustment was used to account for selection bias. One-level and two-level ACDF cohorts were analyzed separately. Unadjusted and propensity-adjusted multivariable logistic regressions were performed to determine the risk of postoperative complications in outpatient cases relative to inpatient cases, as well as predictors of post-discharge complications.
RESULTS: 22,006 ACDF cases were included, of which4,759 were outpatient procedures. Propensity-adjusted differences in preoperative characteristics were allp > 0.5, indicating successful adjustment of selection bias. Among 6,890 two-level cases, of which 1,429 (20.7%) were outpatient, the overall unadjusted rate of complications was 1.47% for outpatients and 3.94% for inpatients, p < 0.001. Propensity-adjusted multivariable regression showed a lower rate of postoperative complications in the outpatient cohort (odds ratio 0.48, 95% confidence interval 0.30-0.75). Greater comorbidity burden as measured by Charlson Comorbidity Index, higher American Society of Anesthesiologists class, chronic steroid use, hypertension, and male gender were independent risk factors for post-discharge complications.
CONCLUSIONS: After adjusting for selection bias and patient risk factors, outpatient two-level ACDF was not associated with increased postoperative morbidity relative to inpatients, and may be considered in appropriately indicated patients.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: To determine the postoperative morbidity of one-level and two-level outpatient anterior cervical discectomy and fusion (ACDF) relative to inpatient cases, and risk factors for post-discharge complications.
SUMMARY OF BACKGROUND DATA: ACDF is increasingly performed as an outpatient procedure, with evidence demonstrating outpatient one-level ACDF to be associated with fewer postoperative complications than inpatients. The postoperative morbidity and safety of outpatient two-level ACDF as a separate cohort is not well understood.
METHODS: ACDF cases from NSQIP 2011-2014 were identified. Differences in baseline characteristics between inpatient and outpatient cases were determined, and propensity score adjustment was used to account for selection bias. One-level and two-level ACDF cohorts were analyzed separately. Unadjusted and propensity-adjusted multivariable logistic regressions were performed to determine the risk of postoperative complications in outpatient cases relative to inpatient cases, as well as predictors of post-discharge complications.
RESULTS: 22,006 ACDF cases were included, of which4,759 were outpatient procedures. Propensity-adjusted differences in preoperative characteristics were allp > 0.5, indicating successful adjustment of selection bias. Among 6,890 two-level cases, of which 1,429 (20.7%) were outpatient, the overall unadjusted rate of complications was 1.47% for outpatients and 3.94% for inpatients, p < 0.001. Propensity-adjusted multivariable regression showed a lower rate of postoperative complications in the outpatient cohort (odds ratio 0.48, 95% confidence interval 0.30-0.75). Greater comorbidity burden as measured by Charlson Comorbidity Index, higher American Society of Anesthesiologists class, chronic steroid use, hypertension, and male gender were independent risk factors for post-discharge complications.
CONCLUSIONS: After adjusting for selection bias and patient risk factors, outpatient two-level ACDF was not associated with increased postoperative morbidity relative to inpatients, and may be considered in appropriately indicated patients.
LEVEL OF EVIDENCE: 3.
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