Wang Xiaofei, Meng Yang, Liu Hao, Hong Ying, Wang Beiyu, Ding Chen, Yang Yi
34753West China Hospital, Sichuan University, Chengdu, China.
Xiaofei Wang and Yang Meng contributed equally to this work and should be considered co-first authors.
Global Spine J. 2021 Sep;11(7):1121-1133. doi: 10.1177/2192568220959265. Epub 2020 Sep 22.
A systematic review and meta-analysis.
Outpatient cervical disc replacement (CDR) has been performed with an increasing trend in recent years. However, the safety profile surrounding outpatient CDR remains insufficient. The present study systematically reviewed the current studies about outpatient CDR and performed a meta-analysis to evaluate the current evidence on the safety of outpatient CDR as a comparison with the inpatient CDR.
We searched the PubMed, Embase, Web of Science, and Cochrane Library databases comprehensively up to April 2020. Patient demographic data, overall complication, readmission, returning to the operation room, operating time were analyzed with the Stata 14 software and R 3.4.4 software.
Nine retrospective studies were included. Patients underwent outpatient CDR were significantly younger (mean difference [MD] = -1.97; 95% CI -3.80 to -0.15; = .034) and had lower prevalence of hypertension (OR = 0.68; 95% CI 0.53-0.87; = .002) compared with inpatient CDR. The pooled prevalence of overall complication was 0.51% (95% CI 0.10% to 1.13%) for outpatient CDR. Outpatient CDR had a 59% reduction in risk of developing complications (OR = 0.41; 95% CI 0.18-0.95; = .037). Outpatient CDR showed significantly shorter operating time (MD = -18.37; 95% CI -25.96 to -10.77; < .001). The readmission and reoperation rate were similar between the 2 groups.
There is a lack of prospective studies on the safety of outpatient CDR. However, current evidence shows outpatient CDR can be safely performed under careful patient selection. High-quality, large prospective studies are needed to demonstrate the generalizability of this study.
系统评价与荟萃分析。
近年来门诊颈椎间盘置换术（CDR）的开展呈上升趋势。然而，围绕门诊CDR的安全性情况仍不充分。本研究系统回顾了关于门诊CDR的现有研究，并进行荟萃分析以评估门诊CDR安全性的当前证据，作为与住院CDR的比较。
我们全面检索了截至2020年4月的PubMed、Embase、Web of Science和Cochrane图书馆数据库。使用Stata 14软件和R 3.4.4软件分析患者人口统计学数据、总体并发症、再入院、返回手术室、手术时间。
纳入9项回顾性研究。与住院CDR相比，接受门诊CDR的患者明显更年轻（平均差[MD]= -1.97；95%置信区间-3.80至-0.15；P =.034），高血压患病率更低（比值比[OR]= 0.68；95%置信区间0.53 - 0.87；P =.002）。门诊CDR总体并发症的合并患病率为0.51%（95%置信区间0.10%至1.13%）。门诊CDR发生并发症的风险降低了59%（OR = 0.41；95%置信区间0.18 - 0.95；P =.037）。门诊CDR的手术时间明显更短（MD = -18.37；95%置信区间-25.96至-10.77；P <.001）。两组的再入院率和再次手术率相似。
缺乏关于门诊CDR安全性的前瞻性研究。然而，当前证据表明，在仔细选择患者的情况下，门诊CDR可以安全进行。需要高质量、大规模的前瞻性研究来证明本研究的可推广性。
