Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel
STUDY DESIGN.Delphi Panel expert panel consensus and narrative literature review OBJECTIVE.To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc repla...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2017-06, Vol.42 (11), p.E648-E659, Article E648 |
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| container_issue | 11 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
| container_volume | 42 |
| creator | Mohandas, Anita Summa, Chris Worthington, W. Bradley Lerner, Jason Foley, Kevin T. Bohinski, Robert J. Lanford, Gregory B. Holden, Carol Wohns, Richard N.W. |
| description | STUDY DESIGN.Delphi Panel expert panel consensus and narrative literature review
OBJECTIVE.To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).
SUMMARY OF BACKGROUND DATA.Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings is lacking.
METHODS.A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Pre-determined consensus was set at 70% for each best-practice statement.
RESULTS.A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and sub-categories) achieved consensus, including pre-operative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6).
CONCLUSIONS.This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.Level of Evidence4 |
| doi_str_mv | 10.1097/BRS.0000000000001925 |
| format | Article |
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OBJECTIVE.To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).
SUMMARY OF BACKGROUND DATA.Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings is lacking.
METHODS.A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Pre-determined consensus was set at 70% for each best-practice statement.
RESULTS.A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and sub-categories) achieved consensus, including pre-operative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6).
CONCLUSIONS.This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.Level of Evidence4</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0000000000001925</identifier><identifier>PMID: 27753787</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Ambulatory Surgical Procedures - methods ; Cervical Vertebrae - surgery ; Consensus ; Delphi Technique ; Humans ; Outpatients ; Spinal Fusion - methods ; Total Disc Replacement - methods</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2017-06, Vol.42 (11), p.E648-E659, Article E648</ispartof><rights>Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2465-5038f0ac59a9601bb43095b27f6df70f8ed2240db845f6032a9be91f2f7df91c3</citedby><cites>FETCH-LOGICAL-c2465-5038f0ac59a9601bb43095b27f6df70f8ed2240db845f6032a9be91f2f7df91c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27753787$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mohandas, Anita</creatorcontrib><creatorcontrib>Summa, Chris</creatorcontrib><creatorcontrib>Worthington, W. Bradley</creatorcontrib><creatorcontrib>Lerner, Jason</creatorcontrib><creatorcontrib>Foley, Kevin T.</creatorcontrib><creatorcontrib>Bohinski, Robert J.</creatorcontrib><creatorcontrib>Lanford, Gregory B.</creatorcontrib><creatorcontrib>Holden, Carol</creatorcontrib><creatorcontrib>Wohns, Richard N.W.</creatorcontrib><title>Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>STUDY DESIGN.Delphi Panel expert panel consensus and narrative literature review
OBJECTIVE.To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).
SUMMARY OF BACKGROUND DATA.Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings is lacking.
METHODS.A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Pre-determined consensus was set at 70% for each best-practice statement.
RESULTS.A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and sub-categories) achieved consensus, including pre-operative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6).
CONCLUSIONS.This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.Level of Evidence4</description><subject>Ambulatory Surgical Procedures - methods</subject><subject>Cervical Vertebrae - surgery</subject><subject>Consensus</subject><subject>Delphi Technique</subject><subject>Humans</subject><subject>Outpatients</subject><subject>Spinal Fusion - methods</subject><subject>Total Disc Replacement - methods</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV1PFDEUhhuikRX8B8T00puBfnfKHawiJiQQPq4nnc6pW-zurG1Hwr-3m0ViCNHenOTkfd-e8xyEDig5pMToo9Prm0Py16OGyR00o5K1DaXSvEEzwhVrmOBqF73P-b6KFKfmHdplWkuuWz1Dt6eQC75K1pXgIGM_Jnw5lbUtAVYFn6wKpFB7c0i_grMR30zpO6THY3wNeYol47M0LrHFnyGuFwFf2RXEffTW25jhw1PdQ3dnX27n583F5ddv85OLxjGhZCMJbz2xThprFKF9Lzgxsmfaq8Fr4lsYGBNk6FshvSKcWdODoZ55PXhDHd9Dn7a56zT-nOoi3TJkBzHWIcYpd7TlUkhqhKpSsZW6NOacwHfrFJY2PXaUdBueXeXZveRZbR-ffpj6JQzPpj8Aq-D4Ra4LpcIbVyXZEJ_T-5RfS2-35ocxVs75R5weIHULsLEs_jeY-Id1I9OK1-MTqkllS5pNS_LfLTWivA</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Mohandas, Anita</creator><creator>Summa, Chris</creator><creator>Worthington, W. Bradley</creator><creator>Lerner, Jason</creator><creator>Foley, Kevin T.</creator><creator>Bohinski, Robert J.</creator><creator>Lanford, Gregory B.</creator><creator>Holden, Carol</creator><creator>Wohns, Richard N.W.</creator><general>Wolters Kluwer Health, Inc. All rights reserved</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170601</creationdate><title>Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel</title><author>Mohandas, Anita ; Summa, Chris ; Worthington, W. Bradley ; Lerner, Jason ; Foley, Kevin T. ; Bohinski, Robert J. ; Lanford, Gregory B. ; Holden, Carol ; Wohns, Richard N.W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2465-5038f0ac59a9601bb43095b27f6df70f8ed2240db845f6032a9be91f2f7df91c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Ambulatory Surgical Procedures - methods</topic><topic>Cervical Vertebrae - surgery</topic><topic>Consensus</topic><topic>Delphi Technique</topic><topic>Humans</topic><topic>Outpatients</topic><topic>Spinal Fusion - methods</topic><topic>Total Disc Replacement - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mohandas, Anita</creatorcontrib><creatorcontrib>Summa, Chris</creatorcontrib><creatorcontrib>Worthington, W. Bradley</creatorcontrib><creatorcontrib>Lerner, Jason</creatorcontrib><creatorcontrib>Foley, Kevin T.</creatorcontrib><creatorcontrib>Bohinski, Robert J.</creatorcontrib><creatorcontrib>Lanford, Gregory B.</creatorcontrib><creatorcontrib>Holden, Carol</creatorcontrib><creatorcontrib>Wohns, Richard N.W.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mohandas, Anita</au><au>Summa, Chris</au><au>Worthington, W. Bradley</au><au>Lerner, Jason</au><au>Foley, Kevin T.</au><au>Bohinski, Robert J.</au><au>Lanford, Gregory B.</au><au>Holden, Carol</au><au>Wohns, Richard N.W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>42</volume><issue>11</issue><spage>E648</spage><epage>E659</epage><pages>E648-E659</pages><artnum>E648</artnum><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>STUDY DESIGN.Delphi Panel expert panel consensus and narrative literature review
OBJECTIVE.To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).
SUMMARY OF BACKGROUND DATA.Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers. The transition from traditional inpatient environments has been enabled by innovation in anesthesia protocols and surgical technique, as well as favorable economics. Studies have demonstrated that anterior cervical surgery (ACDF and CTDR) can be performed safely on an outpatient basis. However, practice guidelines and evidence-based protocols to inform best practices for the safe and efficient performance of these procedures in same-day, ambulatory settings is lacking.
METHODS.A panel of five neurosurgeons, three anesthesiologists, one orthopedic spine surgeon, and a registered nurse was convened to comprise a multidisciplinary expert panel. A three-round modified-Delphi method was used to generate best-practice statements. Pre-determined consensus was set at 70% for each best-practice statement.
RESULTS.A total of 94 consensus statements were reviewed by the panel. After three rounds of review, there was consensus for 83 best-practice statements, while 11 statements failed to achieve consensus. All statements within several perioperative categories (and sub-categories) achieved consensus, including pre-operative assessment (n = 8), home-care/follow-up (n = 2), second-stage recovery (n = 18), provider economics (n = 8), patient education (n = 14), discharge criteria (n = 4), and hypothermia prevention (n = 6).
CONCLUSIONS.This study obtained expert-panel consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (ACDF/CTDR). Given a paucity of guidelines and a lack of established care pathways for ACDF/CTDR in same-day, ambulatory settings, results from this study can supplement available evidence in support of local protocol development for providers considering a transition to the outpatient environment.Level of Evidence4</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>27753787</pmid><doi>10.1097/BRS.0000000000001925</doi></addata></record> |
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| ispartof | Spine (Philadelphia, Pa. 1976), 2017-06, Vol.42 (11), p.E648-E659, Article E648 |
| issn | 0362-2436 1528-1159 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Ambulatory Surgical Procedures - methods Cervical Vertebrae - surgery Consensus Delphi Technique Humans Outpatients Spinal Fusion - methods Total Disc Replacement - methods |
| title | Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel |
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