Introduction: ACDF is a commonly performed procedure for degenerative conditions of the cervical spine. Postoperative hematoma and airway compromise is a life threatening complication. In this study we aim to determine whether an immediate PACU radiograph plays a role in early detection of such complications.
Methods: We reviewed the charts of 1009 patients that underwent an ACDF between September 2013 and February 2017. Patients were categorized into 2 groups, those receiving a PACU radiograph and those who did not. Data collected for this study included patients’ demographics, BMI, smoking, prior neck surgeries, co-morbidities, diagnosis, ASA class, operation level (s), blood loss, intraoperative steroids administration, reintubation, re-operation, length of stay, mortality and number of radiographs, and associated costs for postoperative radiographs and length of hospital stay.
Results: A total of 815 patients were included into our analysis, 558 (68.5%) had a PACU radiograph while 257 (31.5%) did not. We found no statistically significant results with regards to reoperation (p 0.92), reintubation (p 0.94), and mortality (p 0.49) between the two groups. Lengths of stay in patients who received a PACU radiograph were 1.6 ± 2.1 versus 1.1 ± 3.3 days in patients who didn’t (p 0.01). With the average length of stay and radiograph use we estimate that patients who received a PACU radiograph postoperatively cost $558,950.53 while patients who did not receive one cost $158,808.01, adding to expenditure by $400,142.53 over 42 months. Per patient cost was $947.94± 1181.4 for the PACU radiograph group while it was $617.93 ± 1863.1 (p 0.009) for the other group.
Conclusions: Our data did not reveal differences in reoperation, reintubation or mortality between the two groups; however cases where PACU radiograph was obtained were associated with longer length of stay and increased healthcare expenses. Further studies are warranted to validate these results.
Patient Care: Patients potentially can undergo less overall radiation, and be discharged from the hospital sooner. This is also an area in which a decrease in healthcare expenditure can be occur.
Learning Objectives: By the conclusion of this session we hope to portray that:1) no clinical benefit of obtaining a PACU radiograph post ACDF. As clinical signs and symptoms drive management. 2) There is a role of obtaining PACU radiographs in terms of educational purposes and perhaps medicolegal