Doan Matthew K, Chung Andrew S, Makovicka Justin L, Hassebrock Jeffrey D, Polveroni Thomas M, Patel Karan A
Mayo Clinic Alix School of Medicine, Phoenix, AZ.
Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Spine (Phila Pa 1976). 2021 May 15;46(10):658-664. doi: 10.1097/BRS.0000000000003871.
Retrospective cohort study.
The aim of this study was to evaluate the safety of two-level cervical disc replacement (CDR) in the outpatient setting.
Despite growing interest in CDR, limited data exist evaluating the safety of two-level CDR in the outpatient setting.
The National Surgical Quality Improvement Program (NSQIP) database was queried for all two-level anterior cervical discectomy and fusion (ACDF) and CDR procedures between 2015 and 2018. Demographics, comorbidities, and 30-day postoperative complication rates of outpatient two-level CDR were compared to those of inpatient two-level CDR and outpatient two-level ACDF. Radiographic data are not available in the NSQIP.
A total of 403 outpatient CDRs were compared to 408 inpatient CDRs and 4134 outpatient ACDFs. Outpatient CDR patients were older and more likely to have pulmonary comorbidities compared to inpatient CDR (P < 0.03). Outpatient CDR patients were less likely to have an American Society of Anesthesiologists class ≥2 and have hypertension compared to outpatient ACDF patients (P < 0.0001). Outpatient CDR had a lower 30-day readmission rate (0.5% vs. 2.5%, P = 0.02) and lower 30-day reoperation rate (0% vs. 1%, P = 0.047) compared to inpatient CDR. Outpatient CDR had a lower readmission rate (0.5% vs. 2.1%, P = 0.03) compared to outpatient ACDF, but there was no difference in reoperation rates between the two procedures (0% vs. 0.8%, P = 0.07). Outpatient CDR had an overall complication rate of 0.2%, inpatient CDR had a complication rate of 0.9%, and outpatient ACDF had a complication rate of 1.3%. These differences were not significant.
To our knowledge, this is the largest multicenter study examining the safety of two-level outpatient CDR procedures. Outpatient two-level CDR was associated with similarly safe outcomes when compared to inpatient two-level CDR and outpatient two-level ACDF. This suggests that two-level CDR can be performed safely in the outpatient setting.Level of Evidence: 3.
回顾性队列研究。
本研究旨在评估门诊环境下两级颈椎间盘置换术（CDR）的安全性。
尽管人们对CDR的兴趣日益浓厚，但评估门诊环境下两级CDR安全性的数据有限。
查询国家外科质量改进计划（NSQIP）数据库中2015年至2018年间所有的两级前路颈椎间盘切除融合术（ACDF）和CDR手术。将门诊两级CDR的人口统计学、合并症和术后30天并发症发生率与住院两级CDR和门诊两级ACDF进行比较。NSQIP中没有影像学数据。
共比较了403例门诊CDR、408例住院CDR和4134例门诊ACDF。与住院CDR相比，门诊CDR患者年龄更大，更易患肺部合并症（P<0.03）。与门诊ACDF患者相比，门诊CDR患者美国麻醉医师协会分级≥2级及患高血压的可能性更小（P<0.0001）。与住院CDR相比，门诊CDR的30天再入院率更低（0.5%对2.5%，P=0.02），30天再次手术率更低（0%对1%，P=0.047）。与门诊ACDF相比，门诊CDR的再入院率更低（0.5%对2.1%，P=0.03），但两种手术的再次手术率无差异（0%对0.8%，P=0.07）。门诊CDR的总体并发症发生率为0.2%，住院CDR为0.9%，门诊ACDF为1.3%。这些差异无统计学意义。
据我们所知，这是最大的一项多中心研究，考察门诊两级CDR手术的安全性。与住院两级CDR和门诊两级ACDF相比，门诊两级CDR的安全性结果相似。这表明两级CDR可在门诊环境下安全进行。证据等级：3级。
