Instrumented ACDF can be safely performed as an outpatient procedure, study finds

Investigators found rates of hardware-related complications for patients in the study were similar to those reported in the literature.

Performing one- to three-level instrumented anterior cervical discectomy and fusion on an outpatient basis appears feasible, according to a study by Colorado researchers.

Alan T. Villavicencio, MD, and colleagues at Boulder Neurosurgical Associates in Boulder, Colo., reviewed intra- and perioperative complication rates for 103 patients treated with instrumented anterior cervical discectomy and fusion (ACDF) from C2 to T1 at an average age of 50.25 years. They reported their findings in the Spine Journal.

Surgeons treated an average of 1.46 spinal levels and performed single-level ACDF in 59 patients (57%), two-level ACDF in 40 patients (39%) and three-level ACDF in four patients (4%), according to the study.

The 99 patients treated with single- or two-level ACDF were discharged 8 hours after surgery on average, and all were discharged within 15 hours postop. The four patients treated with three-level surgery were discharged after 23 hours of observation, but were considered outpatients in the study, the authors noted.

The researchers found a 3.8% overall complication rate. This included two (1.9%) major complications, such as vertebral fracture, hardware failure requiring another surgery and dehydration that required hospital readmission, and two (1.9%) minor complications, such as transient neurologic deficits or medication reactions not requiring hospitalization, according to the study.

One patient experienced a nerve root injury at C5, which resolved within 2 months from conservative treatment. One patient experienced an asymptomatic left anterior vertebral body fracture at C5, which did not require surgery and had healed by 6 months follow-up. One other patient who underwent a single-level ACDF was readmitted for dehydration and moderate chest pain. This patient was treated with IV fluids and was discharged the next day, according to the study.

The researchers also performed a meta-analysis to compare their complication rates with those of published studies. The literature search yielded nine articles that met inclusion criteria, creating a comparison group of 633 patients.

"The difference in hardware-related complication rates was not found to be statistically significant (P<1) between the meta-analysis comparison and outpatient groups," the authors wrote.

In addition, there was no significant difference in overall complication rates between the meta-analysis comparison and the outpatients included in the study, they noted.

"In our series, the total hardware-related complication rate (0%) compares favorably with previously reported rates identified through our meta-analysis (0.5%). Thus, the trend of typically low hardware-related complication rates can be extrapolated to ambulatory ACDF," the authors wrote.

For more information:
Villavicencio AT, Puchchak E, Burneikiene S, Thramann JJ. The safety of instrumented outpatient anterior cervical discectomy and fusion. Spine J. 2007;7:148-153.