Comparative Non-Inferiority Analysis of Outpatient and Inpatient Laminoplasty for Cervical Spondylosis

Introduction: With increasing evidence supporting outpatient spinal procedures for their reduced hospital-related risks and improved value-based care, this study evaluated whether surgical outcomes of outpatient cervical laminoplasty are non-inferior to those of inpatient procedures for cervical spondylosis.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were analyzed to identify patients who underwent cervical laminoplasty. Patients with hospital stays exceeding 48 hours or those undergoing concurrent spinal procedures were excluded to ensure comparability between groups. Primary outcomes included rates of postoperative complications, 30-day readmissions, and reoperations. Non-inferiority was defined by a risk difference of < 10% within a one-sided 97.5% confidence interval.

Results: A total of 808 cervical laminoplasty cases were included, with 107 outpatient and 701 inpatient procedures. Apart from age (58.3 ± 10.6 vs. 61.4 ± 11.5 years, p=0.01), baseline characteristics were comparable between groups. The incidence of postoperative complications was 2.8% for outpatients and 3.4% for inpatients. Both groups had a 30-day readmission rate of 3.7%. Reoperation rates were 2.8% for outpatients and 1.4% for inpatients. Non-inferiority was confirmed with a risk difference of < 10% across all outcomes.

Conclusion : Outpatient cervical laminoplasty yields comparable early postoperative outcomes to inpatient procedures. The non-inferiority of outpatient surgery was demonstrated for postoperative complications, as well as 30-day readmission and reoperation rates, supporting its viability as a safe and effective alternative to inpatient care.