165 ACDF in the Outpatient Ambulatory Surgery Setting: Analysis of 1000 Consecutive Cases and Comparison to Hospital Inpatient ACDF

INTRODUCTION:Ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. While ASCs offer significant cost advantages over hospital-based surgery, concern over the safety of outpatient anterior cervical discectomy and fusion (ACDF) has slowed its adoption. To date, only a few published series, each underpowered at less than 100 patients, make up the evidence basis for the safety of outpatient ACDF surgery. METHODS:A total of 1000 consecutive patients undergoing ACDF in an ASC and 484 consecutive patients undergoing ACDF in the in-patient hospital setting were included in the study. Data was collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. RESULTS:Of the 1000 outpatient ACDF cases performed in an ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDF. Mean age was 49.5 ± 8.6 and 484 (48.4%) were males. All patients were observed postoperatively at the ASC for 4 hours before being discharged home. Eight (0.8%) patients were transferred from the surgery center to the hospital postoperatively (pain control [n = 3], chest pain and EKG changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], profound postoperative weakness and surgical reexploration [n = 1]). There was no perioperative mortality. Thirty-day hospital readmission was 2.2%. Length of surgery was less with outpatient ACDF. All measures of 90-day surgical morbidity (surgical site infection, dysphagia, hematoma, CSF leak, hoarseness, new neurodeficit, readmission, reoperation) were similar between outpatient vs inpatient ACDF for both 1-level and 2-level ACDF. CONCLUSION:Analysis of 1000 consecutive patients undergoing ACDF in an outpatient setting demonstrated surgical complications occur at a low rate (