Adamson Tim, Godil Saniya S, Mehrlich Melissa, Mendenhall Stephen, Asher Anthony L, McGirt Matthew J
Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; and.
Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee.
J Neurosurg Spine. 2016 Jun;24(6):878-84. doi: 10.3171/2015.8.SPINE14284. Epub 2016 Feb 5.
OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative deaths occurred. The 30-day hospital readmission rate was 2.2%. All 90-day surgical morbidity was similar between outpatient and inpatient cohorts for both 1-level and 2-level ACDFs. CONCLUSIONS An analysis of 1000 consecutive patients who underwent ACDF in an outpatient setting demonstrates that surgical complications occur at a low rate (1%) and can be appropriately diagnosed and managed in a 4-hour ASC PACU window. Comparison with an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising surgical safety. In an effort to decrease costs of care, surgeons can safely perform 1- and 2-level ACDFs in an ASC environment.
目的 在医疗保健成本不断攀升、提高医疗效率和降低医疗成本压力日益增大的时代，门诊手术中心（ASC）已成为许多手术治疗的低成本选择。颈椎前路椎间盘切除融合术（ACDF）是最常见的脊柱手术之一，随着老年人口的增加，其手术频率正在迅速上升。尽管ASC相对于医院手术中心具有显著的成本优势，但对门诊ACDF安全性的担忧减缓了其应用。作者旨在：1）确定在其门诊ASC连续进行的前1000例ACDF手术的安全性；2）将这些门诊ACDF手术的安全性与同期在医院进行的连续ACDF手术的安全性进行比较。方法 本回顾性研究纳入了2006年至2013年在一家ASC接受ACDF手术的1000例连续患者（门诊ACDF组）和在范德比尔特大学医院接受ACDF手术的484例连续患者（住院ACDF组）的病历。收集了患者的人口统计学资料、合并症、手术细节以及围手术期和90天内的发病率数据。比较门诊和住院ACDF组的围手术期发病率和医院再入院率。结果 在作者的ASC进行的前1000例门诊ACDF病例中，629例（62.9%）为单节段ACDF，365例（36.5%）为双节段ACDF。患者平均年龄为49.5±8.6岁，484例（48.4%）为男性。所有患者术后在ASC麻醉后监护病房（PACU）观察4小时后出院回家。8例患者（0.8%）术后从手术中心转至医院（用于控制疼痛[n = 3]、胸痛和心电图改变[n = 2]、术中脑脊液漏[n = 1]、术后血肿[n = 1]以及术后严重虚弱和再次手术探查[n = 1]）。无围手术期死亡发生。30天医院再入院率为2.2%。对于单节段和双节段ACDF，门诊和住院队列的所有90天手术发病率相似。结论 对1000例在门诊环境下接受ACDF手术的连续患者的分析表明，手术并发症发生率较低（1%），并且可以在ASC的4小时PACU观察期内得到适当的诊断和处理。与住院ACDF手术队列的比较显示了相似的结果，突出表明ACDF可以在门诊手术环境中安全进行，而不会损害手术安全性。为了降低医疗成本，外科医生可以在ASC环境中安全地进行单节段和双节段ACDF手术。
