Day surgery for cervical microdiscectomy: is it safe and effective?
The objective of this pilot study was to evaluate the safety and efficacy of cervical discectomy with fusion performed on an outpatient basis. The experimental group (50 consecutive patients) was studied prospectively and the outcomes were compared with 53 consecutive, retrospectively analyzed, admitted controls who underwent the same procedure. Outcomes for both groups were assessed by patient-response questionnaires and clinical examination. At follow-up times of 1.3 (outpatient) and 1.6 (inpatient) years, outcomes (outpatient/inpatient) expressed as percent successful were as follows: Relief of arm pain (80/70%); relief of neck pain (78/68%); relief of arm muscle weakness and atrophy (94/96%); return to normal activities (64/70%); return to work (65/68%); and satisfaction with the results of surgery (86/83%). No statistically significant differences between outpatients and inpatients were found for any of the outcome parameters studied. There was no mortality and the operative complication rate was 2% for each study group. The results indicate that conversion of cervical discectomy with fusion from an admitted to an ambulatory practice did not compromise the safety or efficacy of the surgical procedure. Potential economic savings to overall health costs of the United States that might result from such conversion could exceed $100 million annually.
Silvers
H R
HR
Department of Biometry, State University of New York at Buffalo, USA.
Lewis
P J
PJ
Suddaby
L S
LS
Asch
H L
HL
Clabeaux
D E
DE
Blumenson
L E
LE
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000191:economics / Q000379:methods*; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009133:Muscular Atrophy / Q000209:etiology / Q000601:surgery; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome