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Outpatient ACDF linked with increased rate of perioperative surgical, medical complications

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Don Y. Park

LOS ANGELES — Patients undergoing outpatient anterior cervical discectomy and fusion may have a greater risk for perioperative complications than patients who undergo the surgery as an inpatient procedure, according to results presented at the North American Spine Society Annual Meeting.

In a retrospective review of the Pearl Diver database from 2011 to 2016, Don Y. Park, MD, and colleagues collected age, gender, geographic location, year of procedure and Charlson Comorbidity Index among patients undergoing anterior cervical discectomy and fusion (ACDF). Researchers categorized patients as to whether they underwent inpatient or outpatient ACDF and compared surgical results and surgical and medical complications.

Park noted a greater number of patients underwent inpatient ACDF (10,964 patients vs. 1,315 patients in the outpatient group).

“The relative ratio of outpatient vs. inpatient ACDF decreased with age, and the mean Charlson Comorbidity Index was lower with outpatient vs. inpatient, which is in line with our hypothesis,” Park said in his presentation.

Park noted a two-fold increase in the annual relative incidence of outpatient ACDF from 2011 to 2016. Both groups had equal rates of hardware removal and irrigation and debridement, according to Park.

“[For] posterior fusion at 6 months, there was a statistically significant difference in outpatient ACDF vs. inpatient, with a higher odds ratio,” Park said. “Same for posterior fusion at 1 year, as well as anterior revision and extension at 1 year.”

He added the inpatient and outpatient groups had equal rates of decompression and laminectomy, dural tear and neurologic injury. When looking at medical complications, Park noted equal rates of deep vein thrombosis, pulmonary embolism and pneumonia between the two groups.

“However, the acute renal failure rates were statistically significantly different with ... 1.25 odds ratio,” Park said. “Otherwise, respiratory failure, MI and stroke were equal.” – by Casey Tingle

Reference:

Park DY, et al. Paper 104. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.

Disclosure: Park reports he receives consulting fees from NuVasive and has speaking and/or teaching arrangements with DePuy Synthes.