A study published in the International Journal of Spine Surgery last year examines the safety and feasibility of anterior cervical discectomy and fusion in an ambulatory setting.
The article's authors examined one- and two-level ACDF in the ambulatory setting. There were 119 procedures performed in all. Around 62 percent of the procedures were single-level. Here are five things to know about their findings:
1. Hospital stay for single-level procedures was 4.7 hours on average. The maximum stay time as 8.2 hours; the minimum stay time was 0.8 hours. Ambulatory surgery centers are able to accommodate outpatient procedures. Depending on state regulations, ASCs can keep patients up to 23 hours, and these procedures fall well below that maximum.
2. Average total stay for two-level procedures was 5.4 hours. Maximum length of stay was 9.6 hours and the minimum length of stay was 3.4 hours. Two-level procedures are also feasible in the ASC setting where patients are able to stay for up to 23 hours.
3. The researchers reported no major operating complications, readmission or deaths after discharge. However, there were two transfers from the ambulatory surgical center to inpatient status for observation. "Outpatient one- and two-level ACDF with plate fixation can safely be done on an outpatient ambulatory basis," concluded the study authors. "The data suggests that all subaxial cervical levels can be treated. Patient fusion and satisfaction data were not obtained and thus cannot be commented upon."
4. Performing cases in the ambulatory setting reduces hospitalization time and exposure to nosocomial infections, which the study authors identified as financially beneficial for the healthcare system. Previous studies show the cost of inpatient one- and two-level procedures is $6,739 to $15,000; outpatient ACDF can save between $4,000 and $8,000 on these procedures.
An article published in Spine examined the cost of thoracic and lumbar vertebroplasty from 2001 to 2005 among Medicare part B patients. The nationwide inflation-adjusted charges were $76 million for 14,142 cases in 2001 and $152.3 million for 29,090 cases in 2005. Study authors found inpatient cases generated most of the charges, and noted procedures performed in freestanding facilities were "of growing importance."
5. A separate article published in The Spine Journal went a step further to examine one-, two- and three-level ACDF in the outpatient setting. There were 99 patients who underwent one- and two-level procedures who were discharged in less than 15 hours, and four patients who underwent three-level procedures who were discharged after 23 hours. Complication rate among these patients was 3.8 percent.
This study had a similar conclusion to the authors of other studies on outpatient ACDF: "Performing ACDF with instrumentation on an outpatient basis is feasible and is not associated with higher overall or hardware-related complication rates as compared with complication rates reported in the literature, suggesting that this procedure is safe to perform on an outpatient basis."
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