Introduction: 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. To date, only a few published series, each underpowered at less than 100 patients, comprise the evidence basis for the safety of outpatient ACDF surgery.
Methods: A total of 1000 consecutive patients undergoing ACDF in an ASC and 484 consecutive patients undergoing ACDF in the in-patient hospital setting were included in the study. Data was collected on patient demographics, comorbidities, operative details and peri-operative and 90-day morbidity.
Results: Of the 1000 outpatient ACDF cases performed in an ASC, 629(62.9%) were one-level and 365(36.5%) were two level ACDF. Mean age was 49.5±8.6 and 484(48.4%) were males. All patients were observed postoperatively at the ASC for 4 hours before being discharged home. Eight(0.8%) patients were transferred from the surgery center to the hospital postoperatively [pain control(n=3), chest pain and EKG changes(n=2), intraoperative CSF leak(n=1), postoperative hematoma(n=1), profound postoperative weakness and surgical re-exploration(n=1)]. There was no peri-operative mortality. 30-day hospital re-admission was 2.2%. Length of surgery was less with outpatient ACDF. All measures of 90-day surgical morbidity(SSI, dysphagia, hematoma, CSF leak, hoarseness, new neuro-deficit, re-admission, re-operation) were similar between outpatient vs inpatient ACDF for both single-level and two-level ACDF.
Conclusions: Analysis of 1000 consecutive patients undergoing ACDF in an outpatient setting demonstrated surgical complications occur at a low rate(<1%) and can be appropriately diagnosed and managed in 4 hour ASC PACU window. Comparison to inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in outpatient ambulatory surgery setting without compromising surgical safety. To decrease cost of care, surgeons can safely consider performing one and two-level ACDF in an ASC environment.
Patient Care: For patients undergoing ACDF in an outpatient setting, surgical complications occur at a low rate(<1%) and can be appropriately diagnosed and managed in 4 hour PACU window.
Learning Objectives: Comparison to inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in outpatient ambulatory surgery setting without compromising surgical safety.