Introduction: In an era of escalating healthcare cost and pressure to improve efficiency and cost of care, ambulatory surgery centers(ASCs) have emerged as lower cost options for many surgical therapies. While ASCs offer significant cost advantages over hospital based surgery, concern over the safety of outpatient ACDF has slowed its adoption. We set out to determine the safety of the first 1000 consecutive outpatient ACDF surgeries and compare the quality and safety of outpatient ACDF to consecutive ACDF surgeries performed during the same time period in the hospital setting.
Methods: A total of 1000 consecutive patients undergoing ACDF in an ambulatory surgery center(Outpatient ACDF) and 484 consecutive patients undergoing ACDF at Vanderbilt University Hospital(Inpatient ACDF), from 2006 to 2013 were included. Data was collected on patient demographics, operative details and peri-operative and 90-day morbidity. All peri-operative outcomes and 90-day morbidity was compared between the outpatient and inpatient ACDF groups.
Results: Of the1000 Outpatient ACDF cases, 629 (62.9%) were one-level and 365 (36.5%) were two level ACDF. All patients were observed postoperatively at the ASC for 4 hours before being discharged. Eight (0.8%) patients were transferred from the surgery center to the hospital postoperatively [pain control (n=3), chest pain/EKG changes (n=2), CSF leak (n=1), postoperative hematoma (n=1), profound postoperative weakness and re-exploration (n=1)], Table 1. 30-day hospital re-admission was 2.2%. All 90-day surgical morbidity was similar between outpatient vs inpatient cohort for both single-level and two-level ACDF, Tables 2 & 3.
Conclusions: An analysis of patients undergoing 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 to an inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in the outpatient ambulatory surgery setting without compromising surgical quality and safety.
Patient Care: In our study, an analysis of patients undergoing 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.
Learning Objectives: At the end of the session, participants should be able to: 1) Understand the morbidity associated with ACDF; 2) Compare the differences in morbidity of ACDF performed in inpatient versus outpatient setting.