Spinal fusion: Multilevel procedures in the inpatient vs. outpatient setting: 4 findings

A new study published in the Journal of Neurosurgery: Spine examines the readmission rates for multilevel anterior cervical discectomy and fusion procedures in the outpatient versus inpatient setting.


The retrospective study examined 332 patients who underwent 337 three- or four-level ACDF procedures from May 2012 to June 2017. There were six patients who did not complete full follow-up while 299 patients underwent outpatient procedures and 32 patients had inpatient procedures. Surgeons performed the procedures at six different hospitals.

Key findings include:

1. The overall readmission rate was 1.2 percent, with inpatient procedures reporting a higher readmission rate than the outpatient procedures. The inpatient readmission rate was 3.1 percent, compared to 1 percent for outpatient procedures.

2. The patients who underwent outpatient surgery had increased readmission risk due to comorbidities that included coronary artery disease and autoimmune disease. The outpatient cohort also had increased risk with patients who had diabetes and chronic kidney disease.

3. The researchers reported complications perioperatively including delirium and surgical site infection; those complications were linked to increased 30-day hospital readmission for the outpatient cohort when compared with the inpatient cohort.

4. The study authors concluded their report demonstrated the effectiveness of three- and four-level spinal fusions in the ASC. "Patient selection for outpatient three- and four-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection."

More articles on spine surgery:
Awake spinal fusion - 5 key findings
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Spinal fusion with stem cells vs. BMP: 4 key findings

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