title: Anterior cervical decompression and fusion with plate fixation as an outpatient procedure.
abstract: BACKGROUND
  Outpatient cervical spine surgery has previously been described for posterior laminoforaminotomy and anterior microdiscectomy with allograft fusion. Anterior cervical discectomy and fusion (ACDF) with plate fixation has not, to our knowledge, been described as an outpatient procedure.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the safety and feasibility of ACDF with instrumentation when performed as an outpatient in a free-standing ambulatory surgical center. Additionally, the authors sought to determine any patient selection bias and its effect on outcome.
  
  
  METHODS
  This study is a retrospective medical record review.
  
  
  METHODS
  The sample included all patients who underwent one or two level ACDF with plate fixation at levels C4-5 or below as an adjunct to autogenous iliac crest bone graft or structural allograft from 1998 to 2002 by the two senior authors.
  
  
  METHODS
  Complications were assessed clinically with special attention to dysphagia and respiratory complications. Inpatient lengths of stay and postoperative hospital admission or readmission were also measured.
  
  
  METHODS
  Thirty consecutive patients were treated at a free-standing ambulatory surgery center, whereas two control groups, each of 30 consecutive patients, had surgery performed in the hospital and were admitted overnight for observation. The first control group consisted of admitted patients before the commencement of patient selection for the outpatient group; the second control group was comprised of admitted patients who had surgery performed concurrently with the outpatient group. The study group was evaluated on the first postoperative day and 3 weeks after surgery.
  
  
  RESULTS
  Ninety patients underwent ACDF plate fixation at 140 different levels. Forty patients were treated at one level, and 50 were treated at two levels. The three groups were comparable in age, sex, and body mass index. There were no major complications. Seven patients (13%) had minor postoperative complications among the controls: transient dysphagia in three (5%) and graft donor site pain in four (14%). Three patients (10%) in the outpatient group had minor complications (all had dysphagia). Among the controls, four patients (7%) had increased length of stay owing to complications. Four patients (7%) in the combined control group were readmitted for early complications; no patient was admitted for a complication after outpatient surgery.
  
  
  CONCLUSIONS
  In the present study, selection criteria for outpatient surgery included one or two level involvement C4-5 or lower, absence of myelopathy, subjective neck size, and estimated operative time. The data did not otherwise suggest a difference in the surgical populations. The outpatient group had a lower complication rate compared with the controls. This was likely the result of selection bias. Transient dysphagia was the most prevalent complication in the outpatient group.
authors.affiliation: Department of Orthopaedic Surgery, Monmouth Medical Center, 300 Second Ave., Long Branch, NJ 07740, USA. stiebermd@yahoo.com
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Stieber
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Donald
authors.forename: Jason D
authors.initials: JD
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D001860:Bone Plates; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D011859:Radiography; D013123:Spinal Fusion