Janesh Karnati, B.A.: No financial relationships to disclose
Introduction: Performing Anterior Cervical Discectomy and Fusion (ACDF) in an outpatient setting has proven to be far more cost-effective than inpatient while retaining similar rates of morbidity and readmission. The safety and effectiveness of outpatient one- and two-level ACDF is well established, however, there is a significant lack of information on 3- and 4-level ACDF in a similar context.
Methods: This retrospective cohort study included adult patients (aged ≥18 years) undergoing 3- or 4-level ACDF by two fellowship trained spine surgeons at a quaternary referral center from January 1, 2019, to January 1, 2024. The primary outcome was the incidence of post-operative surgical complication (defined as composite measure of hematoma, surgical site infection, wound dehiscence, esophageal injury, and need for return to OR). The secondary outcomes were 30- and 90-day hospital readmission rates. The exploratory outcomes were factors associated with an increased risk of complications/readmission in the same-day discharge cohort.
Results: A total of 44 patients met inclusion criteria (mean age, 62.5 [SD, 9.5] years; 26 [59%] female), with 14/44 (31.8%) being discharged on the same calendar day. The overall post-operative complication rate was 4.5% with a higher rate observed in the SDD group, however this difference was not significant (7.14% vs 3.33%, p = 0.572). One patient in the SDD group required a return to the OR, although this finding was not statistically significant (p = 0.572). Readmission rates within 30 days were higher in SDD group (7.14% vs 6.66%, p = 0.953) and readmission rates within 90 days were higher in the non-SDD group (6.67% vs 0%, p = 1) however neither of these differences were statistically significant. In the SDD group, smoking status and hypertension were associated with higher odds of a post-operative surgical complication (OR = 6.33 and OR=1.42, respectively) though these associations were not statistically significant (p = 0.286 and p=0.838, respectively).
Conclusion : This single institutional study suggests that in appropriately selected patients undergoing 3- and 4-levels ACDFs, same calendar day discharges are not associated with high rates of adverse events, 30- or 90-day hospital readmission. Larger prospective studies are needed to corroborate our findings.